McCusker Jane, Karp Igor, Cardin Sylvie, Durand Pierre, Morin Jacques
Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Montréal, Québec, Canada.
Acad Emerg Med. 2003 Dec;10(12):1362-70. doi: 10.1111/j.1553-2712.2003.tb00011.x.
To conduct a systematic review of the literature on the determinants of hospital emergency department (ED) visits by elders, using a modification of the Andersen behavioral model of health services, adapted to explain ED utilization.
Relevant articles were identified through MEDLINE and a search of reference lists and personal files. Studies of populations aged 65 or older in which ED visits were a study outcome were included if they were: original, not restricted to a particular medical condition, written in English or French, and investigated one or more determinants. Data were abstracted and checked by two authors using a standard protocol.
Fourteen studies (reported in 15 articles) were reviewed, 10 community-based and four using clinical samples. Among ten studies that measured multiple determinants, determinants reported from multivariate analyses included measures of need (perceived and evaluated health status, prior utilization), predisposing factors (health beliefs and sociodemographic variables), and enabling factors (physician availability, regular source of care, family resources, geographical access to services).
Need is usually the primary determinant of ED visits in older people. Controlling for need, predisposing and enabling factors that promote access to primary medical care are associated with reduced ED utilization.
采用经修改的适用于解释急诊科利用情况的安德森卫生服务行为模型，对有关老年人医院急诊科就诊决定因素的文献进行系统综述。
通过医学文献数据库（MEDLINE）以及对参考文献列表和个人文档的检索来确定相关文章。纳入年龄在65岁及以上人群中以急诊科就诊作为研究结果的研究，条件如下：原创研究、不限于特定医疗状况、以英文或法文撰写且调查了一个或多个决定因素。由两位作者使用标准方案提取并核对数据。
共审查了14项研究（发表于15篇文章中），其中10项基于社区，4项使用临床样本。在测量多个决定因素的10项研究中，多变量分析报告的决定因素包括需求指标（感知和评估的健康状况、既往利用情况）、易患因素（健康观念和社会人口统计学变量）以及促成因素（医生可及性、常规医疗来源、家庭资源、地理上的服务可及性）。
需求通常是老年人急诊科就诊的主要决定因素。在控制需求的情况下，促进获得初级医疗服务的易患因素和促成因素与急诊科利用率降低相关。
