及时获得初级保健服务的实际障碍：对成年人使用急诊科服务的影响。

Practical barriers to timely primary care access: impact on adult use of emergency department services.

作者信息

Rust George, Ye Jiali, Baltrus Peter, Daniels Elvan, Adesunloye Bamidele, Fryer George Edward

机构信息

National Center for Primary Care, Morehouse School of Medicine, 720 Westview Dr, Atlanta, GA 30310, USA.

出版信息

Arch Intern Med. 2008 Aug 11;168(15):1705-10. doi: 10.1001/archinte.168.15.1705.

DOI:10.1001/archinte.168.15.1705

PMID:18695087

Abstract

BACKGROUND

Most Americans report having a usual source of medical care, but many also report significant barriers to timely access to such care. This can lead patients to use the emergency department (ED) as a ready alternative to their usual source of medical care, even when such care could be provided more cost-effectively in a primary care setting. The purpose of this study was to examine the relationship between ED visits and perceived barriers to receiving timely primary care.

METHODS

Among 30,677 adults 18 years or older participating in the adult sample section of the National Health Interview Survey, 23,413 who reported having a usual source of medical care other than the ED and answered the questions related to barriers were included in our analyses. Associations between perceived timely access barriers and reported use of ED in the previous 12 months were examined using logistic regression to control for covariates that also affect ED use.

RESULTS

For those reporting no access barriers, 1 in 5 adult Americans in the noninstitutionalized civilian population visited an ED at least once during the preceding year. For those reporting 1 or more barriers, the proportion having an ED visit was 1 in 3. Four of the 5 following timely access barriers was independently associated with ED use, even after adjusting for other socioeconomic and health-related factors: (1) "couldn't get through on phone" (OR [odds ratio], 1.27; 95% confidence interval [CI], 1.02-1.59); (2) "couldn't get appointment soon enough" (OR, 1.45; 95% CI, 1.21-1.75); (3) "waiting too long in doctor's office" (OR, 1.20; 95% CI, 1.02-1.41); (4) "not open when you could go" (OR, 1.24; 95% CI, 0.99-1.55); and (5) "no transportation" (OR, 1.88; 95% CI, 1.50-2.35).

CONCLUSIONS

The benefits of having a usual source of medical care are diminished by barriers that limit effective and timely access to such care. Interventions to improve effective access to medical care such as open access scheduling might have benefits not only for individual patients and practices but also for health policy related to cost-effective health care delivery systems and our need to relieve overcrowded conditions at EDs.

摘要

背景

大多数美国人表示有常规的医疗保健来源，但也有许多人表示在及时获得此类保健方面存在重大障碍。这可能导致患者将急诊科（ED）作为其常规医疗保健来源的现成替代选择，即使在初级保健环境中可以更经济高效地提供此类保健。本研究的目的是探讨急诊就诊与及时获得初级保健的感知障碍之间的关系。

方法

在参与全国健康访谈调查成人样本部分的30677名18岁及以上成年人中，我们纳入了23413名报告有除急诊科之外的常规医疗保健来源并回答了与障碍相关问题的人进行分析。使用逻辑回归来控制也会影响急诊就诊的协变量，以检验感知到的及时就诊障碍与过去12个月内报告的急诊就诊之间的关联。

结果

对于那些报告没有就诊障碍的人，在非机构化平民人口中，每5名美国成年人中就有1人在上一年至少去过一次急诊科。对于那些报告有1个或更多障碍的人，急诊就诊的比例为三分之一。在调整了其他社会经济和健康相关因素后，以下5个及时就诊障碍中的4个与急诊就诊独立相关：（1）“电话打不通”（比值比[OR]，1.27；95%置信区间[CI]，1.02 - 1.59）；（2）“无法尽快预约”（OR，1.45；95%CI，1.21 - 1.75）；（3）“在医生办公室等待时间过长”（OR，1.20；95%CI，1.02 - 1.41）；（4）“你能去的时候不开门”（OR，1.24；95%CI，0.99 - 1.55）；（5）“没有交通工具”（OR，1.88；95%CI，1.50 - 2.35）。