Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria.
PLoS One. 2012;7(8):e41775. doi: 10.1371/journal.pone.0041775. Epub 2012 Aug 28.
In an emergency room of internal medicine, triage and treatment of patients deserve first priority. However, biopsychosocial case complexity may also affect patient health outcome but has not yet been explored in this setting. Therefore, the aims of the study are (1) to estimate prevalence rates of complex patients in the emergency room (ER), (2) to describe biopsychosocial complexity in this population and (3) to evaluate possible correlations between patient profiles regarding case complexity and further clinical treatment.
During a study period of one week, all patients of an emergency room of internal medicine who were triaged to Manchester levels three to five were invited to participate in the study. Biopsychosocial case complexity was assessed by the INTERMED method. Psychosocial interventions were evaluated based on all documented interventions and recommendations given at the emergency room and during inpatient treatment.
Study participants consisted of 167 patients with a subgroup of 19% (n = 32) receiving subsequent inpatient-treatment at the department. High biopsychosocial case complexity was found in 12% (n = 20) of the total sample (INTERMED score >20). This finding was paralleled by a cluster analysis suggesting three clusters with one highly complex patient group of 14%. These highly complex patients differed significantly from the other clusters as they had visited the emergency room more often within the last year and lived alone more frequently. In addition, admission rates were highest in this group. During ER treatment and subsequent inpatient treatment, 21% of highly complex patients received interventions addressing psychosocial factors as compared to 6% and 7%, respectively, in the other clusters.
A standardized screening of biopsychosocial case complexity among 'frequent utilizers' of the ER would be helpful to detect specific multidisciplinary health care needs among this particularly burdened patient group.
在内科急诊室，对患者进行分诊和治疗应优先考虑。然而，生物心理社会病例的复杂性也可能影响患者的健康结果，但尚未在这种环境下进行探索。因此，本研究的目的是：(1) 估计急诊室(ER)中复杂患者的患病率；(2) 描述该人群的生物心理社会复杂性；(3) 评估患者的病例复杂性和进一步临床治疗的相关特征。
在一周的研究期间，邀请所有被分诊至曼彻斯特三级至五级的内科急诊室患者参加研究。采用 INTERMED 方法评估生物心理社会病例的复杂性。根据急诊室和住院治疗期间记录的所有干预措施和建议，评估心理社会干预措施。
研究参与者包括 167 名患者，其中有 19%（n=32）的患者随后在该科住院治疗。在总样本中（INTERMED 评分>20），有 12%（n=20）的患者存在较高的生物心理社会病例复杂性。聚类分析表明存在三个聚类，其中一个高度复杂的患者组占 14%。与其他聚类相比，这些高度复杂的患者在过去一年中更频繁地到急诊室就诊，且更经常独自生活。此外，该组的住院率最高。在急诊室治疗和随后的住院治疗期间，21%的高度复杂患者接受了针对心理社会因素的干预措施，而其他两个聚类组分别为 6%和 7%。
对急诊室“频繁使用者”进行生物心理社会病例复杂性的标准化筛查，有助于发现这一负担较重的患者群体的特定多学科医疗保健需求。
