Stoddart D, Ireland A J, Crawford R, Kelly B
Glasgow Royal Infirmary, 84 Castle Street, Glasgow G40SF.
Health Bull (Edinb). 1999 May;57(3):186-91.
To determine the impact, in terms of new attendance figures and types of patients attending, on a city centre accident and emergency (A & E) department following the establishment of out-of-hours primary care emergency centres (PCECs) in Glasgow.
A questionnaire survey of A&E patients attending out-of-hours at Glasgow Royal Infirmary A&E department, a city centre department with approximately 68,000 new annual attendances, one week before (Group A), twelve weeks after (Group B) and one year after (Group C) the introduction of PCECs. Main outcome measures were attendance numbers within working hours and out-of-hours, reason for A&E attendance, duration of presenting condition, whether primary care services were contacted and awareness of the new primary care emergency centres.
In respect of out-of-hours attendances, 612 questionnaires were completed for group A, 715 for group B and 645 for group C. There was no significant difference in the type of presenting complaints between the groups, i.e. illness or injury. The majority of patients presented within 24 hours of the onset of their condition (82%, 79% and 80% of patients in groups A, B and C respectively). There was a reduction in those attending with conditions of more than one week's duration (8% in group A, 7% in group B and 5% in group C). There was a decrease in the number of patients who considered their problem to be non-urgent (27% in group A, 22% in group B and 16% in group C). Prior to the introduction of the PCEC service 18% of patients (108) had contacted their GP before attending, compared with only 9% (63) of group B and 9% (57) of group C patients. Of these patients there was a significant decrease in the number of patients attending following GP referral. Of the patients who had not contacted the primary care services only 35% (201) knew of the introduction of PCECs 12 weeks later, increasing to 52% (291) after one year (p < 0.01). Significance calculations were performed using a Difference of Proportion Test with a 99% significance level.
Our results suggest that the new PCEC service has not had a significant impact on the number or type of patients attending this A&E department, with fewer self-referred patients contacting primary care services after its introduction. Following the introduction of the PCECs there was a trend towards more patients attending A&E following telephone advice although amongst self-referred A&E patients there remained a large proportion who claimed to be unaware of the new service 12 weeks after, and one year after, the introduction of PCECs. Continued evaluation of the effect on A&E of the new centres will be required to plan future resources for the provision of emergency care.
确定在格拉斯哥设立非工作时间初级医疗急救中心（PCECs）后，对市中心一家事故与急救（A&E）部门的新就诊人数及就诊患者类型产生的影响。
对格拉斯哥皇家医院A&E部门非工作时间就诊的患者进行问卷调查，该部门位于市中心，每年约有68000名新就诊患者。调查时间分别为引入PCECs前一周（A组）、引入后十二周（B组）和引入后一年（C组）。主要观察指标为工作时间内和非工作时间的就诊人数、A&E就诊原因、病情持续时间、是否联系过初级医疗服务以及对新初级医疗急救中心的知晓情况。
关于非工作时间就诊情况，A组完成612份问卷，B组完成715份，C组完成645份。各组就诊主诉类型（即疾病或损伤）无显著差异。大多数患者在病情发作后24小时内就诊（A组、B组和C组分别为82%、79%和80%的患者）。病程超过一周的就诊患者有所减少（A组为8%，B组为7%，C组为5%）。认为自己问题不紧急的患者数量有所下降（A组为27%，B组为22%，C组为16%）。在引入PCEC服务之前，18%的患者（108人）在就诊前联系过他们的全科医生，而B组只有9%（63人），C组只有9%（57人）。在这些患者中，全科医生转诊后就诊的患者数量显著减少。在未联系初级医疗服务的患者中，只有35%（201人）在12周后知道引入了PCECs，一年后这一比例增至52%（291人）（p < 0.01）。显著性计算采用比例差异检验，显著性水平为99%。
我们的结果表明，新的PCEC服务对该A&E部门的就诊患者数量或类型没有显著影响，引入后自行就诊并联系初级医疗服务的患者减少。引入PCECs后，尽管在自行就诊的A&E患者中，仍有很大比例的人在引入PCECs 12周后和一年后声称不知道这项新服务，但在电话咨询后前往A&E就诊的患者有增加的趋势。需要持续评估新中心对A&E的影响，以便为未来的急救护理资源规划提供依据。
