University of Toledo College of Medicine, Toledo, Ohio, USA.
Emerg Med J. 2012 Jan;29(1):28-31. doi: 10.1136/emj.2010.103077. Epub 2010 Dec 23.
The number of annual patient visits to US emergency departments (ED) has been increasing since 1995, whereas the number of ED is decreasing. Previous studies have identified many reasons why patients seek care in ED, including lack of access to care elsewhere, lack of insurance, inability to see their doctor in a timely manner and lower levels of social support. This study identifies factors that influence patients' decisions to seek care in ED and assesses their access to primary care.
A prospective study, conducted by standardised verbal interview with adult ED patients, was performed in the XXX ED during June-July 2009. Non-English speaking patients, the mentally incapacitated and those under severe distress were excluded. Consenting patients were asked a series of questions on access to primary care, factors that influenced their decision to attend the ED, health insurance status and demographic information.
Among 292 study participants (89% response rate), the majority were over 40 years (52%), Caucasian (69%) and unemployed (58%). Among employed participants, 66% (N=88/133) of employers offered health insurance. Most participants had a primary care physician (PCP; 73%; N=214), but a minority had called their PCP about the current problem (31%; N=78/253). Most participants came to the ED because of convenience/location (41%) or preference for this institution (23%). Participants came to the ED, rather than their regular doctor, because they had no PCP (27%), an emergency condition (19%), or communication challenges (17%).
Convenience, location, institutional preference and access to other physicians are common factors that influence patients' decisions to seek care in ED.
自 1995 年以来，美国急诊部（ED）的年就诊患者人数一直在增加，而 ED 的数量却在减少。先前的研究已经确定了患者为何选择在 ED 就诊的许多原因，包括无法在其他地方获得医疗服务、缺乏保险、无法及时看医生以及社会支持水平较低。本研究确定了影响患者选择在 ED 就诊的因素，并评估了他们获得初级保健的情况。
2009 年 6 月至 7 月，在 XXX ED 通过标准口头访谈对成年 ED 患者进行了前瞻性研究。排除不会说英语、精神障碍和处于严重痛苦中的患者。同意参与研究的患者被问及一系列有关获得初级保健、影响他们选择去 ED 的因素、健康保险状况和人口统计学信息的问题。
在 292 名研究参与者中（89%的应答率），大多数人年龄在 40 岁以上（52%），白种人（69%）和失业（58%）。在有雇主的参与者中，66%（88/133）的雇主提供健康保险。大多数参与者有初级保健医生（PCP；73%；N=214），但只有少数人因当前问题致电 PCP（31%；N=78/253）。大多数参与者选择来 ED 是因为方便/位置（41%）或对该机构的偏好（23%）。参与者选择来 ED 而不是他们的常规医生，是因为他们没有 PCP（27%）、紧急情况（19%）或沟通障碍（17%）。
便利性、位置、机构偏好以及获得其他医生的机会是影响患者选择在 ED 就诊的常见因素。
