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背景英国国家健康与临床卓越研究所发布相关指南,慢性肾脏疾病管理已经成为全科医生工作的一个重要组成部分。慢性肾脏疾病(G4阶段和G5阶段)患者通常患有并发症,疾病进展各异,患者年龄一般较大。全科医生对晚期慢性肾脏疾病患者的管理决策问题较大,例如何时将患者转诊到肾脏科。目的探讨全科医生对晚期慢性肾脏疾病患者管理和二次护理转诊的看法。设计和场所在英国4个地区进行定性研究,包括伦敦、布里斯托尔、伯明翰和斯蒂夫尼奇。方法对19名全科医生进行半结构式访谈。对转录采访进行主题方面的分析。结果全科医生对晚期慢性肾脏疾病患者管理和指导的经验较少,包括对正在接受血液分析和保守治疗(无血液分析或移植)的患者。一些全科医生仅根据患者的肾功能和一些更宽泛的标准进行患者转诊,比如年龄和多重病症。全科医生发现国家指南和地区建议不符,某些全科医生从患者出院回归初级医疗的案例中总结经验。如果患者未出现其他问题,或者患者无意进行血液分析,那么慢性肾脏疾病管理经验较丰富的全科医生会较晚进行患者转诊或者不对患者进行转诊。结论全科医生需要年长晚期慢性肾脏疾病患者和其并发症管理指导,需要对地区和国家的转诊标准进行统一。全科医生一般对肾脏科病房的常规护理项目认识不足。然而,全科医生乐于进行此类护理,或者主导肾脏科治疗团队进行常规管理。
Background The National Institute of Health and Clinical Excellence publishes guidelines that chronic kidney disease management has become an integral part of the work of general practitioners. Patients with chronic kidney disease (stage G4 and stage G5) usually have complications, diseases progress differently, and patients are generally older. General practitioners have a greater regulatory decision making in patients with advanced CKD, such as when to refer patients to the department of nephrology. Objective To explore the views of general practitioners on the management of patients with advanced chronic kidney disease and the second nursing referral. Design and Locations Qualitative research has been conducted in four areas in the United Kingdom, including London, Bristol, Birmingham and Stevenage. Methods Semi-structured interviews with 19 general practitioners. Transcription interviews conducted thematic analysis. Results GPs have less management and guidance in patients with advanced CKD, including those who are undergoing blood analysis and conservative treatment (no blood analysis or transplantation). Some GPs refer patients only based on their kidney function and some of the more general criteria, such as age and multiple conditions. General practitioners found inconsistent national guidelines and regional recommendations and some GPs summed up their experience with patients returning to primary care after discharge. If there are no other problems with the patient or if the patient does not intend to perform a blood analysis, then a GP who is more experienced in chronic kidney disease management will either refer the patient later or will not refer the patient. CONCLUSIONS GPs need guidance on management of elderly patients with advanced CKD and their complications and need to harmonize regional and national referral criteria. General practitioners generally lack knowledge about routine care programs in nephrology wards. However, general practitioners are happy with these types of care, or they lead the nephrology team in routine management.