Orientation and Development of General Practice Department of General Hospital in Hierarchical Diagnosis and Treatment Based on Disease Spectrum of Outpatients

doi:10.3969/j.issn.1007-9572.2016.28.007

Abstract

Abstract: Objective　Through analysis of disease spectrum of outpatients in general practice department of general hospital,to explore the orientation and development of general practice department of general hospital in hierarchical diagnosis and treatment.Methods　Patients who received treatment in outpatient clinic of General Practice Department,the Second Hospital of Hebei Medical University from 2014 to 2015 were selected as the research objects.The basic condition and disease information of the patients,including their gender,age,date of visiting,reason of visiting hospital,diagnosis and return visit,were collected and retrospectively analyzed.The data came from the electronic medical record that provided by the information center of this hospital.The standard of disease classification adopted the second edition of International Classification of Primary Care （ICPC-2）.Results　The total number of patients consulting in outpatient clinic was 1 338 500,the number of patients visiting a doctor in outpatient clinic was 111 635,including 54 701 （49.00%） men and 56 934 women （51.00%）;subjects aged from 1 to 99 had an average age of （41.5 ± 24.5）;there were 39 042 （34.97%） referrals from primary care institutions;57 077 （51.13%） were patients of first visit,54 558 （48.87%） patients with repeated visits;61 343 （54.95%） patients had multi-system diseases.After receiving treatment in the outpatient clinic of general practice department,3 552 （3.18%） inpatients were admitted into general practice wards,217 inpatients with clear diagnosis were referred to specialist wards （occupied 6.11% of inpatients number in general practice wards）;2 145 （1.92%） inpatients referred to specialist outpatient for seeking treatment;2 452 （2.20%） patients were directly referred to every specialist ward from outpatient clinic of general practice.The top five diseases of the highest number of visits were hypertension （13 173,11.80%）,coronary heart disease （12 726,11.40%）,diabetes （6 698,6.00%）,cerebrovascular disease （5 917,5.30%）,upper respiratory tract infection （4 912,4.40%）.The top five diseases system of the highest number of visits were circulatory system （23 556,21.10%）,nervous system （14 724,13.19%）,digestive system （12 739,11.41%）,respiratory system （11 721,10.50%）,psychological system （11 164,10.00%）.Conclusion　Most of the diseases of patients in general practice outpatient clinic of general hospital are chronic diseases,common diseases or common symptoms,covering almost all the system diseases,most patients have subsequent visits and less were referred to specialist;the exploration of establishing medical consortium that based on general practice department of general hospital helps to realize two-way referral and hierarchical diagnosis and treatment.

Key words: General practice department, Hospitals,general, Hierarchical diagnosis and treatment, Outpatients, Disease spectrum

摘要： 目的　通过分析综合医院全科医疗科门诊就诊疾病谱，旨在探索综合医院全科医疗科在分级诊疗中的定位与发展。方法　选取2014—2015年在河北医科大学第二医院全科医疗科门诊就诊的患者为研究对象。收集并回顾性分析就诊患者的基本情况和疾病信息，包括患者的性别、年龄、就诊日期、就诊原因、诊断及复诊情况等，资料来源于由该院信息中心统一调出的电子病历。疾病分类标准采用基层医疗国际分类第2版（ICPC-2）。结果　门诊就医咨询患者共1 338 500人次，门诊就诊患者共111 635人次，其中男54 701人次（49.00%），女56 934人次（51.00%）；年龄1～99岁，平均年龄（41.5±24.5）岁；由基层医疗卫生机构转诊患者39 042人次（34.97%）；初诊患者57 077人次（51.13%），重复就诊患者54 558人次（48.87%）；患有多系统疾病的患者61 343人次（54.95%）。全科医疗科门诊就诊后，收入全科病房住院患者共3 552人次（3.18%），住院后诊断明确转入专科病房住院患者共217人次（占全科病房住院人次的6.11%）；转入专科门诊就诊患者共2 145人次（1.92%）；由全科门诊直接收入各专科病房住院患者共2 452人次（2.20%）。就诊人次最高的前5位疾病分别为高血压（13 173人次，11.80%）、冠心病（12 726人次，11.40%）、糖尿病（6 698人次，6.00%）、脑血管病（5 917人次，5.30%）、上呼吸道感染（4 912人次，4.40%）。就诊人次最高的前5位疾病系统分别为循环系统（23 556人次，21.10%）、神经系统（14 724人次，13.19%）、消化系统（12 739人次，11.41%）、呼吸系统（11 721人次，10.50%）、精神心理（11 164人次，10.00%）。结论　综合医院全科医疗科门诊患者就诊疾病多为慢性病、常见病或常见症状，几乎涵盖了所有系统疾病，复诊患者多，向专科转诊少；探索建立以综合医院全科医疗科为基础的医疗联合体有利于实现双向转诊和分级诊疗。

关键词: 全科医疗科, 医院, 综合, 分级诊疗, 门诊病人, 疾病谱

WANG Rong-ying, LI Feng, ZHI Xiao, HE Zhen-yin, WANG Yan, ZHAO Wen-wen, WANG Ya-yi, ZHANG Min. Orientation and Development of General Practice Department of General Hospital in Hierarchical Diagnosis and Treatment Based on Disease Spectrum of Outpatients[J]. Chinese General Practice, 2016, 19(28): 3417-3421.

王荣英, 李峰, 支晓, 贺振银, 汪雁, 赵稳稳, 王雅依, 张敏. 基于门诊就诊疾病谱分析的综合医院全科医疗科在分级诊疗中的定位与发展探讨[J]. 中国全科医学, 2016, 19(28): 3417-3421.

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