Lee A, Lau F L, Hazelett C B, Kam C W, Wong P, Wong T W, Chow S
Department of Community and Family Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
Hong Kong Med J. 2001 Jun;7(2):131-8.
To study the morbidity patterns of non-urgent patients utilising accident and emergency services and compare these patients with 'true' accident and emergency cases. To analyse the morbidity pattern of non-urgent cases over different time periods, and across different age groups.
A cross-sectional study completed over a 1-year period.
Four accident and emergency departments in Hong Kong.
Two thousand, four hundred and ten patients randomly selected from four accident and emergency departments.
The morbidity patterns by body system, according to the International Classification of Primary Care, were tabulated and analysed for 'true' accident and emergency cases versus non-urgent cases. The ten most frequent diagnoses for the 'true' accident and emergency and non-urgent cases were also compared. Further analysis of accident and emergency service utilisation was conducted comparing different age groups, and also different time periods.
Significantly more cases presenting to the accident and emergency service with respiratory and digestive problems were found to be non-urgent, rather than appropriate accident and emergency cases. In contrast, significantly more cases presenting with circulatory and neurological problems were appropriate cases for accident and emergency department management. The morbidity pattern for the ten most frequent diagnoses seen in non-urgent cases was noted to be similar to the Hong Kong general practice morbidity pattern for self-limiting conditions. Utilisation of accident and emergency services for acute self-limiting conditions was more marked in the late evening, and also among children and the younger population in general.
The utilisation of accident and emergency services by patients requiring a general practice service only, reflects problems in the primary health care delivery system. These may be solved by appropriate interfacing between general practitioners and other service providers, with the aim of providing seamless health care. Without revision of primary health care services, accident and emergency departments will continue to be used inappropriately by patients as an alternative to general practice care.
研究使用急症室服务的非急症患者的发病模式，并将这些患者与“真正的”急症病例进行比较。分析不同时间段和不同年龄组中非急症病例的发病模式。
一项为期1年的横断面研究。
香港的四个急症室。
从四个急症室随机选取2410名患者。
根据基层医疗国际分类法，按身体系统列出并分析“真正的”急症病例与非急症病例的发病模式。还比较了“真正的”急症和非急症病例中最常见的十种诊断。对急症室服务的使用情况进行了进一步分析，比较了不同年龄组和不同时间段。
发现因呼吸和消化问题前往急症室就诊的非急症病例明显多于合适的急症病例。相比之下，因循环和神经问题就诊的病例明显更适合急症室处理。非急症病例中最常见的十种诊断的发病模式与香港一般基层医疗中自限性疾病的发病模式相似。急性自限性疾病在急症室的就诊率在深夜以及儿童和一般年轻人群中更为明显。
仅需要基层医疗服务的患者使用急症室服务，反映了基层医疗服务体系存在的问题。这些问题可以通过全科医生与其他服务提供者之间的适当对接来解决，目的是提供无缝的医疗服务。如果不修订基层医疗服务，急症室将继续被患者不恰当地用作基层医疗服务的替代选择。
