Abstract：
The growing demand for referrals is a main policy concern in health systems. One approach involves the development of demand management tools in the form of clinical prioritization to regulate patient referrals from primary care to specialist care. For clinical prioritization to be effective, it is critical that general practitioners (GPs) assess patient priority in the same way as specialists. The progressive development of IT tools in clinical practice, in the form of electronic referrals support systems (e-RSS), can facilitate clinical prioritization. In this study, we tested if higher use of e-RSS or higher use of high-priority categories was associated with the degree of agreement and therefore consensus on clinical priority between GPs and specialists. We found that higher use by GPs of the e-RSS tool was positively associated with greater degree of priority agreement with specialists, while higher use of the high-priority categories was associated with lower degree of priority agreement with specialists. Furthermore, female GPs, GPs in association with others, and GPs using a specific electronic medical record showed higher agreement with specialists. Our study therefore supports the use of electronic referrals systems to improve clinical prioritization and manage the demand of specialist visits and diagnostic tests. It also shows that there is scope for reducing excessive use by GPs of high-priority categories.
摘要：
对转诊的需求不断增长是卫生系统的主要政策关切。一种方法涉及以临床优先次序的形式开发需求管理工具，以规范从初级保健到专科护理的患者转诊。为了使临床优先排序有效，全科医生(GP)以与专家相同的方式评估患者优先级至关重要.IT工具在临床实践中的逐步发展，以电子推荐支持系统(e-RSS)的形式，可以促进临床优先排序。在这项研究中,我们测试了更高的e-RSS使用率或更高的高优先级类别使用率是否与全科医生和专科医生之间的一致程度相关,因此也就临床优先级达成了共识.我们发现，全科医生对e-RSS工具的更高使用与与专家达成更高的优先级协议呈正相关。而高优先级类别的使用率越高，与专家的优先级协议程度越低。此外，女性GP,全科医生与其他人合作，使用特定电子病历的全科医生与专家的一致性更高。因此，我们的研究支持使用电子转诊系统来改善临床优先级并管理专家就诊和诊断测试的需求。它还表明，有减少GP过度使用高优先级类别的空间。
