Dorn Tina, Yzermans C Joris, Kerssens Jan J, Spreeuwenberg Peter M M, van der Zee Jouke
Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
Med Care. 2006 Jun;44(6):581-9. doi: 10.1097/01.mlr.0000215924.21326.37.
The impact of disasters on primary healthcare utilization is largely unknown. Moreover, it is often overlooked how disaster affects those closest to the primary victims, their family members.
The objective of this study was to examine the long-term effects of a catastrophic fire on primary healthcare utilization.
We conducted a prospective, population-based cohort study covering 1 year pre- and 3 years postfire. Utilization data were extracted from primary care records.
Subjects consisted of 286 disaster victims, 802 family members of disaster victims, 3722 community control subjects, and 10,230 patients from a national reference population.
As outcome measures, we studied 1) the annual number of contacts in primary care and 2) the annual number of contacts for problems related to mental health. Determinants are injury characteristics of victims and bereavement. All analyses control for age, gender, and insurance status.
Being an uninjured victim who witnessed the disaster increases the number of contacts by a factor of 1.55 during the first year postfire (95% confidence interval [CI], 1.35-1.78). Uninjured victims contact the family practitioner more often for mental health-related problems than adolescent community control subjects (incidence rate ratio [IRR], 4.54; 95% CI, 1.69-12.20). In adult family members, the loss of a child predicts overall utilization (IRR, 1.88; 95% CI, 1.35-2.63) and utilization for mental health (IRR, 8.69; 95% CI, 2.10-35.92) during the first year postfire.
Attention should be paid to the primary care needs of bereaved individuals and those who have witnessed the disaster.
灾害对初级医疗保健利用的影响在很大程度上尚不清楚。此外，灾害如何影响最接近主要受害者的人，即他们的家庭成员，这一点常常被忽视。
本研究的目的是调查一场灾难性火灾对初级医疗保健利用的长期影响。
我们进行了一项基于人群的前瞻性队列研究，涵盖火灾前1年和火灾后3年。利用数据从初级保健记录中提取。
研究对象包括286名灾难受害者、802名灾难受害者家属、3722名社区对照对象以及来自全国参考人群的10230名患者。
作为结局指标，我们研究了1）初级保健中的年度就诊次数，以及2）与心理健康相关问题的年度就诊次数。决定因素是受害者的受伤特征和丧亲情况。所有分析均对年龄、性别和保险状况进行了控制。
作为目睹灾害的未受伤受害者，在火灾后的第一年，就诊次数增加了1.55倍（95%置信区间[CI]，1.35 - 1.78）。未受伤的受害者因心理健康相关问题比青少年社区对照对象更频繁地联系家庭医生（发病率比[IRR]，4.54；95% CI，1.69 - 12.20）。在成年家庭成员中，孩子的死亡预示着火灾后第一年的总体利用率（IRR，1.88；95% CI，1.35 - 2.63）和心理健康方面的利用率（IRR，8.69；95% CI，2.10 - 35.92）。
应关注丧亲者以及目睹灾害者的初级保健需求。
