Alderman Elizabeth M, Avner Jeffrey, Racine Andrew
Children's Hospital at Montefiore, Bronx, NY, USA.
J Prim Care Community Health. 2012 Jan 1;3(1):36-41. doi: 10.1177/2150131911413595. Epub 2011 Jul 7.
Many of the 18 million emergency department visits by adolescents annually in the United States are for nonurgent problems that might be addressed in a primary care setting.
As part of a larger randomized controlled intervention, 1023 adolescents aged 12 to 21 years registering in an urban pediatric emergency department (PED) were tracked over the subsequent 365 days to record all visits to the PED. Adolescents identifying an adolescent medicine service (AMS) as the primary care source were compared with adolescents receiving primary care elsewhere in an integrated urban medical system (non-AMS) to determine how often after the index PED visit they revisited the PED, returned to primary care (PC), visited a subspecialist (SS), or were hospitalized. Mean values and odds ratios of each type of visit were compared between AMS and non-AMS patients using multivariate logistic and ordinary least squares regressions to control for covariates.
AMS patients (n = 124, 12%), compared to non-AMS patients (n = 899, 88%), were more likely female (75% vs 48%, P < .001) and used public insurance (52% vs 40%, P = .017). In unadjusted comparisons, AMS and non-AMS patients did not differ in the probability of any return PED visit (46% vs 37%, P = .052) in the 365 days following the index PED visit but differed in the mean number of return PED visits (1.35 vs 0.93, P = .026). AMS patients were more likely to be hospitalized (15% vs 7%, P = .006) after the index PED visit and also had a greater mean number of hospitalizations (0.41 vs 0.19, P = .048). Multivariate analyses controlling for demographic variables, triage level of initial PED visit, and hospitalizations showed AMS patients returned to primary care after an index PED visit 24.6 days earlier than non-AMS patients (P = .026).
This study demonstrates attending an AMS for primary care predicted earlier return to the primary care provider after an index PED visit. Elements of adolescent specialty care producing such outcomes are worthy of further study.
在美国，每年有1800万青少年前往急诊科就诊，其中许多是因非紧急问题，这些问题或许可在初级保健机构解决。
作为一项规模更大的随机对照干预研究的一部分，对在一家城市儿科急诊科（PED）登记的1023名12至21岁青少年进行了为期365天的跟踪，以记录他们前往该急诊科的所有就诊情况。将指定青少年医学服务（AMS）为初级保健来源的青少年与在城市综合医疗系统中其他地方接受初级保健的青少年（非AMS）进行比较，以确定在首次PED就诊后，他们再次前往PED、返回初级保健（PC）、就诊专科医生（SS）或住院的频率。使用多变量逻辑回归和普通最小二乘法回归对AMS和非AMS患者之间各类就诊的均值和比值比进行比较，以控制协变量。
AMS患者（n = 124，12%）与非AMS患者（n = 899，88%）相比，女性比例更高（75%对48%，P <.001），且使用公共保险的比例更高（52%对40%，P =.017）。在未经调整的比较中，AMS和非AMS患者在首次PED就诊后的365天内再次前往PED就诊的概率无差异（46%对37%，P =.052），但再次前往PED就诊的平均次数存在差异（1.35对0.93，P =.026）。AMS患者在首次PED就诊后住院的可能性更大（15%对7%，P =.006），且住院的平均次数也更多（0.41对0.19，P =.048）。在控制了人口统计学变量、首次PED就诊的分诊级别和住院情况的多变量分析中，AMS患者在首次PED就诊后返回初级保健的时间比非AMS患者早24.6天（P =.026）。
本研究表明，在初级保健中接受AMS服务可预测在首次PED就诊后更早返回初级保健提供者处。产生此类结果的青少年专科护理要素值得进一步研究。
