Baskin Avi S, Kwan Lorna, Connor Sarah E, Maliski Sally L, Litwin Mark S
Department of Urology, David Geffen School of Medicine at the University of California, Los Angeles, CA.
Department of Urology, David Geffen School of Medicine at the University of California, Los Angeles, CA.
Urol Oncol. 2016 Jan;34(1):3.e15-21. doi: 10.1016/j.urolonc.2015.08.017. Epub 2015 Sep 26.
Self-efficacy has been strongly associated with health behavior and health maintenance. We examined the relationship between patient-provider self-efficacy and emergency department usage in low-income, underinsured, or uninsured patients with prostate cancer.
We prospectively analyzed quality of life, behavior, and self-efficacy data from men enrolled in a state-funded program providing free prostate cancer care. We summarized patient characteristics stratified by self-efficacy scores (high, mid, and low) and by emergency department visit (any vs. none). We conducted a multivariate repeated measures regression analysis with negative binomial distribution to calculate predicted counts of emergency department visits over time across the self-efficacy strata.
Our cohort included 469 men with a maximum follow-up time of 84 months. Of these men, 70 had visited the emergency department during their enrollment for a total of 118 unique visits. The regression analysis demonstrated a decreasing number of emergency department visits over time for the low (P = 0.0633) and mid (P = 0.0450) self-efficacy groups but not for the high self-efficacy group (P = 0.1155). Pain (22.9%), urinary retention (18.6%), and fever (5.9%) were the most common reasons for emergency department visits.
Patients with low and mid self-efficacy had a decreasing number of emergency department usage over time. Those with high self-efficacy did not follow these trends. Interventions to improve communication between patients and primary treatment teams could prove beneficial in avoiding excess emergency department use.
自我效能感与健康行为及健康维持密切相关。我们研究了低收入、未参保或无保险的前列腺癌患者的医患自我效能感与急诊科就诊之间的关系。
我们前瞻性地分析了参加一项由州政府资助的提供免费前列腺癌护理项目的男性的生活质量、行为和自我效能感数据。我们总结了按自我效能感得分（高、中、低）和急诊科就诊情况（有就诊与无就诊）分层的患者特征。我们进行了负二项分布的多变量重复测量回归分析，以计算不同自我效能感分层随时间的急诊科就诊预测次数。
我们的队列包括469名男性，最长随访时间为84个月。在这些男性中，70人在入组期间去过急诊科，共进行了118次不同的就诊。回归分析表明，低自我效能感组（P = 0.0633）和中等自我效能感组（P = 0.0450）随时间的急诊科就诊次数减少，但高自我效能感组未出现这种情况（P = 0.1155）。疼痛（22.9%）、尿潴留（18.6%）和发热（5.9%）是急诊科就诊最常见的原因。
低自我效能感和中等自我效能感的患者随时间的急诊科就诊次数减少。高自我效能感的患者则未遵循这些趋势。改善患者与初级治疗团队之间沟通的干预措施可能有助于避免过度使用急诊科。
