Donker Gé A, van der Velden Peter G, Kerssens Jan J, Yzermans C Joris
Netherlands Institute for Health Services Research, 3500 BN Utrecht, The Netherlands.
Fam Pract. 2008 Apr;25(2):92-7. doi: 10.1093/fampra/cmn007. Epub 2008 Feb 27.
To assess the characteristics and implications for care of infrequent attendance in general practice in the aftermath of disaster.
A study of the content of electronic medical records (EMRs) in pre- and post-disaster periods linked to an enquiry using self-reported questionnaires administered 3 weeks and 18 months post-disaster. The disaster (explosion of a firework depot in Enschede, The Netherlands) caused 23 deaths, about 1000 people injured and 1200 people who had to relocate. Sample included survivors (N = 922) who participated in two surveys and whose data could be linked to EMRs of GPs. A comparison of reported morbidity in 'infrequent' (a maximum of three times in men and four times in women in the first two post-disaster years) and 'more frequent attenders' (frequency determined post-disaster) in general practice examined in relation to health status (measured by diagnoses in EMRs, symptom checklist and quality of life instrument) was the
Infrequent attenders reported approximately three times as few contacts as more frequent attenders in the pre-disaster year (P < 0.001). Multivariate logistic regression analyses revealed that infrequent attenders were likely to be younger, less depressed, have better subjective health and physical functioning and exhibited more hostile behaviour (measured by questionnaire). Infrequent attenders were less often personally bereaved by the disaster, but more often relocated, and had a lower prevalence of psychological problems pre- and post-disaster although this increased stronger (by 10-fold).
Both groups showed the same type of psychological problems post-disaster, but differed in the frequency of contacting the GP.
评估灾难后基层医疗中不常就诊的特点及其对医疗护理的影响。
一项关于灾难前后电子病历（EMR）内容的研究，该研究与在灾难发生后3周和18个月进行的自我报告问卷调查相关联。这场灾难（荷兰埃因霍温一个烟花仓库爆炸）导致23人死亡，约1000人受伤，1200人被迫撤离。样本包括参与两项调查的幸存者（N = 922），其数据可与全科医生的电子病历相链接。对基层医疗中“不常就诊者”（灾难后的头两年男性最多就诊三次，女性最多就诊四次）和“更常就诊者”（灾难后确定就诊频率）报告的发病率进行比较，并结合健康状况（通过电子病历中的诊断、症状清单和生活质量工具进行衡量）进行研究。
在灾难前一年，不常就诊者报告的就诊次数约为更常就诊者的三分之一（P < 0.001）。多变量逻辑回归分析显示，不常就诊者可能更年轻，抑郁程度更低，主观健康和身体功能更好，且表现出更多敌对行为（通过问卷调查衡量）。不常就诊者因灾难而个人丧亲的情况较少，但搬迁的情况较多，灾难前后心理问题的患病率较低，尽管患病率增长幅度更大（增长了10倍）。
两组在灾难后都出现了相同类型的心理问题，但在联系全科医生的频率上有所不同。
