Santos Martín M D, Bascuñana Morejón de Girón J, Lumbreras García G, Alvarez Martín E, Martínez Pascual B, Sanz Correcher P, Hernando de Larramendi C, Mancebo Aragoneses L
Medicina Familiar y Comunitaria, Hospital Severo Ochoa, Leganés, Madrid.
An Med Interna. 2000 Aug;17(8):410-5.
To analyse the psychosocial characteristics of frequent emergency department (ER) users with a relevant non-organic component and estimate the generated costs.
Retrospective-descriptive study (Jan 1996-Jun 1997) about overusers (OU) defined as > = 3 visits/6 months during at least two 6 months periods, coming to our hospital's emergency department. Reviewing their medical records and making a psychiatric interview we identified Non-organic OU (NOU). Subsequently we estimated the cost generated by discharge visits during the first six months of 1997.
Sixty six out of 220 OU were identified as NOU. The mean consultation rate was 11.3 +/- 9.4. Clinician-psychiatrist agreement on non-organicity was 72.7%. The most frequent diagnoses were: personality disorders (37.5%) and depression-anxiety (35%). Psychiatric OU were significantly younger (51.7 vs 62.5 years) and attended more often (17.6 vs. 9.9 times). In six months only one of 240 ER consultation cause admission. The mean cost of each discharge episode was 8682.9 +/- 6633.8 pta (25.06% due to variable costs). The cost per minute of emergency room stay was 19.26 ptas. Overall NOU attention cost during the six month period studied was 1,903,775 ptas (0.36% of overall ER costs).
Compared with the rest of users, NOU entail a higher burden for the ER. Mentally-ill patients are younger and consult more frequently than the rest of OU. Only 25% of the cost per consultation is due to treatments, tests or diets.
分析有相关非器质性成分的急诊科频繁就诊者的心理社会特征，并估算产生的费用。
对1996年1月至1997年6月期间我院急诊科的过度使用者（OU）进行回顾性描述性研究，OU定义为在至少两个6个月期间内每6个月就诊次数≥3次。通过查阅他们的病历并进行精神科访谈，我们确定了非器质性OU（NOU）。随后我们估算了1997年前六个月出院就诊产生的费用。
220名OU中有66名被确定为NOU。平均就诊率为11.3±9.4。临床医生与精神科医生在非器质性方面的一致性为72.7%。最常见的诊断是：人格障碍（37.5%）和抑郁 - 焦虑（35%）。精神科OU明显更年轻（51.7岁对62.5岁）且就诊更频繁（17.6次对9.9次）。在六个月内，240次急诊就诊中只有一次导致住院。每次出院事件的平均费用为8682.9±6633.8比塞塔（25.06%归因于可变成本）。急诊室停留每分钟的费用为19.26比塞塔。在所研究的六个月期间，NOU的总体诊疗费用为1903775比塞塔（占急诊科总费用的0.36%）。
与其他使用者相比，NOU给急诊科带来了更高的负担。精神疾病患者比其他OU更年轻且就诊更频繁。每次就诊费用中只有25%用于治疗、检查或饮食。
