秘鲁交通事故受害者对护理及时性和质量的患者观点：一项横断面主动监测研究。

Patient perspectives on the promptness and quality of care of road traffic incident victims in Peru: a cross-sectional, active surveillance study.

作者信息

Miranda J Jaime, Rosales-Mayor Edmundo, Quistberg D Alex, Paca-Palao Ada, Gianella Camila, Perel Pablo, Lopez Luis, Luna Diego, Best Pablo, Huicho Luis

机构信息

Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; School of Medicine, Universisdad Peruana Cayetano Heredia, Lima, Peru ; CRONICAS, Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru ; EDHUCASALUD, Asociación Civil para la Educación en Derechos Humanos con Aplicación en Salud, Lima, Peru.

Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; School of Medicine, Universisdad Peruana Cayetano Heredia, Lima, Peru ; Centro de Trastornos Respiratorios del Sueño (CENTRES), Clínica Anglo Americana, Lima, Peru ; Grupo de Investigación en Sueño (GIS), Lima, Peru ; Hospital Clínic de Barcelona, Barcelona, 08036, Spain.

出版信息

F1000Res. 2013 Aug 9;2:167. doi: 10.12688/f1000research.2-167.v1. eCollection 2013.

DOI:10.12688/f1000research.2-167.v1

PMID:24358877

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3814912/

Abstract

BACKGROUND

Road injuries are the second-leading cause of disease and injury in the Andean region of South America. Adequate management of road traffic crash victims is important to prevent and reduce deaths and serious long-term injuries.

OBJECTIVE

To evaluate the promptness of health care services provided to those injured in road traffic incidents (RTIs) and the satisfaction with those services during the pre-hospital and hospital periods.

METHODS

We conducted a cross-sectional study with active surveillance to recruit participants in emergency departments at eight health care facilities in three Peruvian cities: a large metropolitan city (Lima) and two provincial cities (an urban center in the southern Andes and an urban center in the rainforest region), between August and September 2009. The main outcomes of interest were promptness of care, measured by time between injury and each service offered, as well as patient satisfaction measured by the Service Quality (SERVQUAL) survey. We explored the association between outcomes and city, type of health care facility (HCF), and type of provider.

RESULTS

We recruited 644 adults seeking care for RTIs. This active surveillance strategy yielded 34% more events than anticipated, suggesting under-reporting in traditional registries. Median response time between a RTI and any care at a HCF was 33 minutes overall and only 62% of participants received professional care during the initial "golden" hour after the RTI. After adjustment for various factors, there was strong evidence of higher global dissatisfaction levels among those receiving care at public HCFs compared to private ones (odds ratio (OR) 5.05, 95% confidence interval (CI) 1.88-13.54). This difference was not observed when provincial sites were compared to Lima (OR 1.41, 95% CI 0.42-4.70).

CONCLUSIONS

Response time to RTIs was adequate overall, though a large proportion of RTI victims could have received more prompt care. Overall, dissatisfaction was high, mainly at public institutions indicating much need for improvements in service provision.

摘要

背景

道路伤害是南美洲安第斯地区疾病和伤害的第二大原因。对道路交通事故受害者进行妥善管理对于预防和减少死亡及严重的长期伤害至关重要。

目的

评估为道路交通事故（RTIs）受伤者提供的医疗服务的及时性以及在院前和住院期间对这些服务的满意度。

方法

我们于2009年8月至9月在秘鲁三个城市的八家医疗机构的急诊科进行了一项主动监测的横断面研究，以招募参与者。这三个城市分别是一个大城市（利马）和两个省级城市（安第斯山脉南部的一个城市中心以及雨林地区的一个城市中心）。主要关注的结果是护理的及时性，通过受伤与提供的每项服务之间的时间来衡量；以及通过服务质量（SERVQUAL）调查来衡量的患者满意度。我们探讨了结果与城市、医疗机构类型（HCF）和提供者类型之间的关联。

结果

我们招募了644名因RTIs寻求治疗的成年人。这种主动监测策略产生的事件比预期多34%，这表明传统登记中存在报告不足的情况。RTI与HCF的任何护理之间的中位响应时间总体为33分钟，只有62%的参与者在RTI后的最初“黄金”小时内接受了专业护理。在对各种因素进行调整后，有强有力的证据表明，与私立医疗机构相比，在公立HCF接受护理的人群中全球不满水平更高（优势比（OR）5.05，95%置信区间（CI）1.88 - 13.54）。将省级医疗机构与利马进行比较时未观察到这种差异（OR 1.41，95% CI 0.42 - 4.70）。