Department of Community and Preventive Medicine, University of Rochester, Rochester, New York 14642, USA.
J Rural Health. 2011 Winter;27(1):39-49. doi: 10.1111/j.1748-0361.2010.00313.x.
Emergency Department (ED) use among the rural elderly may present a different pattern from the urban elderly, thus requiring different policy initiatives. However, ED use among the rural elderly has seldom been studied and is little understood.
To characterize factors associated with having any versus no ED use among the rural elderly.
A cross-sectional and observational study of 1,736 Medicare beneficiaries age 65 and older who live in nonmetropolitan areas. The data are from the 2002 to 2005 Medical Expenditure Panel Survey (MEPS). A logistic regression model was estimated that included measures of predisposing characteristics, enabling factors, need variables, and health behavior as suggested by Anderson's behavioral model of health service utilization.
During a 1-year period, 20.8% of the sample had at least 1 ED visit. Being widowed, more educated, enrolled in Medicaid, with fair/poor self-perceived physical health, respiratory diseases, and heart disease were associated with a higher likelihood of having any ED visits. However, residing in the western and southern United States and being enrolled in Medicaid managed care were associated with lower probability of having any ED visits. While Medicaid enrollees who reported excellent, very good, good, or fair physical health were more likely to have at least 1 ED visit than those not on Medicaid, Medicaid enrollees reporting poor physical health may be less likely to have any ED visits.
Policy makers and hospital administrators should consider these factors when managing the need for emergency care, including developing interventions to provide needed care through alternate means.
农村老年人在急诊科的就诊情况可能与城市老年人有所不同，因此需要采取不同的政策措施。然而，农村老年人在急诊科的就诊情况很少被研究，也知之甚少。
描述与农村老年人是否使用急诊科相关的因素。
这是一项横断面和观察性研究，纳入了居住在非大都市地区的 1736 名年龄在 65 岁及以上的 Medicare 参保者，数据来自 2002 至 2005 年的医疗支出面板调查（MEPS）。使用安德森健康服务利用行为模型中建议的易感性特征、实现因素、需要变量和健康行为的措施，对一个逻辑回归模型进行了估计。
在 1 年期间，样本中有 20.8%的人至少有 1 次急诊科就诊。丧偶、受教育程度较高、参加医疗补助、自我感知身体健康状况一般/较差、患有呼吸道疾病和心脏病与更高的急诊科就诊可能性相关。然而，居住在美国西部和南部以及参加医疗补助管理式医疗保健与较低的急诊科就诊可能性相关。尽管报告身体健康状况极佳、非常好、好或一般的医疗补助参保者比未参加医疗补助的参保者更有可能至少有 1 次急诊科就诊，但报告身体健康状况较差的医疗补助参保者可能不太可能有任何急诊科就诊。
政策制定者和医院管理人员在管理急诊护理需求时应考虑这些因素，包括制定通过替代方式提供所需护理的干预措施。
