Shesser R, Kirsch T, Smith J, Hirsch R
Department of Emergency Medicine, George Washington University, Washington, DC 20037.
Ann Emerg Med. 1991 Jul;20(7):743-8. doi: 10.1016/s0196-0644(05)80835-2.
To describe the motivation for emergency department use by patients with minor illnesses and compare the demographics and social class characteristics of these patients with those of the general ED population.
Observational, case-control study.
Urban ED.
A sample group of 325 adult, nongeriatric patients with minor illnesses was selected by screening all patients registering in the ED between 9:00 AM and 6:00 PM on 15 randomly selected weekdays. A patient was included in this study group if the chief complaint, method of arrival, and subsequent evaluation met predetermined criteria for minor illness. A comparison group (control) was composed of all ED patients (224) who presented during two randomly selected 24-hour periods that did not overlap with the times of study group enrollment.
Sample group patients were interviewed concerning their socioeconomic backgrounds, reasons for using the ED, and perceptions of the urgency of their conditions. Comparison group patients' interviews were confined to the collection of demographic and socioeconomic information.
There were more men (P = .12), more self-pay patients (P = .017), and fewer Medicare patients (P less than .001) in the study group. There also was a strong trend toward higher income (P = .059) in the study group. The racial, marital, employment, and educational backgrounds of the two groups were similar. Eighty-two percent of the study group had no chronic illness, and only 36% reported a problem of more than three days' duration. Patients chose to use the ED because of its convenience (23.7%), the absence of previous provider relationships (22.1%), and the inability to make a prompt appointment with their regular provider (19.0%). Major differences existed between the reasons for which different demographic and socioeconomic groups chose ED care. Study group patients believed that less than 24 hours should elapse between the onset of their problem and the time at which they receive medical care.
There are no major differences in ED use for minor illness patients from different racial, educational, and economic backgrounds. These patients tend to have a low frequency of chronic illness and often have no established health care provider. They choose the ED for its ease of access and the wide scope of care that can be delivered.
描述轻症患者前往急诊科就诊的动机，并比较这些患者与急诊科普通患者群体的人口统计学和社会阶层特征。
观察性病例对照研究。
城市急诊科。
通过对15个随机选择的工作日上午9点至下午6点在急诊科登记的所有患者进行筛查，选取了325名成年非老年轻症患者组成样本组。如果主诉、就诊方式及后续评估符合轻症的预定标准，则该患者纳入本研究组。对照组由在两个随机选择的24小时时间段内就诊的所有急诊科患者（224名）组成，这两个时间段与研究组入组时间不重叠。
对样本组患者就其社会经济背景、前往急诊科就诊的原因以及对自身病情紧急程度的认知进行访谈。对照组患者的访谈仅限于收集人口统计学和社会经济信息。
研究组男性更多（P = 0.12），自费患者更多（P = 0.017），医疗保险患者更少（P < 0.001）。研究组中收入较高也有很强的趋势（P = 0.059）。两组的种族、婚姻状况、就业和教育背景相似。研究组中82%的患者无慢性病，只有36%的患者报告问题持续超过三天。患者选择前往急诊科是因为其便利性（23.7%）、之前没有与医疗机构建立关系（22.1%）以及无法及时预约其常规医疗机构的医生（19.0%）。不同人口统计学和社会经济群体选择急诊科就诊的原因存在重大差异。研究组患者认为从出现问题到接受医疗护理的时间间隔应少于24小时。
不同种族、教育程度和经济背景的轻症患者在急诊科就诊方面没有重大差异。这些患者慢性病发病率往往较低，且通常没有固定的医疗服务提供者。他们选择急诊科是因为其就诊方便且能提供广泛的医疗服务。
