Shaw Eric K, Howard Jenna, Clark Elizabeth C, Etz Rebecca S, Arya Rajiv, Tallia Alfred F
J Health Care Poor Underserved. 2013 Aug;24(3):1288-305. doi: 10.1353/hpu.2013.0140.
Emergency department (ED) use for non-urgent needs is widely viewed as a contributor to various health care system flaws and inefficiencies. There are few qualitative studies designed to explore the complexity of patients' decision-making process to use the ED vs. primary care alternatives. In this study, semi-structured interviews were conducted with 30 patients who were discharged from the low acuity area of a university hospital ED. A grounded theory approach including cycles of immersion/crystallization was used to identify themes and reportable interpretations. Patients reported multiple decision-making considerations that hinged on whether or not they knew about primary care options. A model is developed depicting the complexity and variation in patients' decision-making to use the ED. Optimizing health system navigation and use requires improving objective factors such as access and costs as well as subjective perceptions of patients' health care, which are also a prominent part of their decision-making process.
急诊科用于非紧急需求的情况被广泛认为是导致各种医疗保健系统缺陷和效率低下的一个因素。很少有定性研究旨在探讨患者在选择急诊科而非初级保健替代方案时决策过程的复杂性。在本研究中，对30名从大学医院急诊科低急症区出院的患者进行了半结构化访谈。采用包括沉浸/结晶循环在内的扎根理论方法来确定主题和可报告的解释。患者报告了多个决策考量因素，这些因素取决于他们是否了解初级保健选项。开发了一个模型来描述患者选择急诊科时决策的复杂性和多样性。优化卫生系统导航和使用需要改善诸如可及性和成本等客观因素，以及患者对医疗保健的主观认知，这些也是他们决策过程的重要组成部分。
