Alfaro C, Brodin M, Lombrail P, Fontaine A, Gottot S
Département de Santé Publique, Faculté Xavier-Bichat, Université Paris VII.
Arch Fr Pediatr. 1992 Nov;49(9):785-91.
The increasing shortage of financial resources requires optimal use of hospital care by patients. However, the studies carried out to date in France have been limited to patients who are hospitalized, and have not included those seen as out-patients.
All patients seen as out-patients in 10 hospitals in the Paris district (3 pediatric hospitals and 7 pediatric departments located in hospitals for adults and children), during the week of 19-26 April 1989, were given a questionnaire on the age, sex, nationality, socio-cultural and economic features of the family, history of earlier medical visits or admissions, the existence of pediatrician or practitioner, and the means and time taken to get to the hospital. Medical diagnosis was established for each patient following the WHO International Classification of Diseases (9th edition).
2,365 out of 2,675 questionnaires were usable. The main features were: 50% of patients were less than 3 years old, 55% were of French origin; 78% belonged to families with relatively low socio-economic status. Both parents had professional activities in 49% of families, 7% of mothers did not speak or write French. The ratio of patients aged less than 3 years admitted to the emergency ward was higher than the average. The most frequent diseases presented by these patients were respiratory (23%), infectious (14%), gastro-intestinal (10%) and neurological (7%); 14% of the patients were seen for symptoms that could not be assigned to a specific disease. 39% of patients were seen in out-patient clinics and 61% in emergency wards. 40% were sent by a health professional to out-patient clinics and only 25% to emergency wards.
Despite the fact that this study is subject to particular conditions, i.e., relative frequency of infectious diseases due to seasonal causes, it suggests that the hospital is becoming the primary source of health care with an increasing percentage of patients seen in "emergency", even though this emergency is often more apparent than real. Health care networks should be established.
财政资源日益短缺，这就要求患者对医院护理进行优化利用。然而，法国迄今开展的研究仅限于住院患者，并未涵盖门诊患者。
1989年4月19日至26日这一周，对巴黎地区10家医院（3家儿科医院以及7家设在成人与儿童医院中的儿科科室）的所有门诊患者进行问卷调查，内容涉及年龄、性别、国籍、家庭的社会文化与经济特征、既往就诊或住院史、是否有儿科医生或执业医生，以及前往医院的方式和所需时间。依据世界卫生组织《国际疾病分类》（第9版）为每位患者确立医学诊断。
2675份问卷中有2365份可用。主要特征如下：50%的患者年龄小于3岁，55%为法国籍；78%属于社会经济地位相对较低的家庭。49%的家庭父母双方都有职业活动，7%的母亲不会说法语或书写法语。年龄小于3岁的患者入住急诊病房的比例高于平均水平。这些患者最常见的疾病为呼吸系统疾病（23%）、感染性疾病（14%）、胃肠道疾病（10%）和神经系统疾病（7%）；14%的患者所表现出的症状无法归为特定疾病。39%的患者在门诊就诊，61%在急诊病房就诊。40%的患者由卫生专业人员转诊至门诊，而仅有25%被转诊至急诊病房。
尽管本研究存在特殊情况，即因季节性原因导致传染病相对高发，但这表明医院正成为医疗保健的主要来源，在“急诊”就诊的患者比例不断增加，即便这种急诊往往更多是表面而非实际的。应建立医疗保健网络。
