Maeland J G, Havik O E
Institute of Hygiene and Social Medicine, University of Bergen, Norway.
Scand J Soc Med. 1989;17(1):93-102. doi: 10.1177/140349488901700114.
Short-term and long-term use of physician consultations and rehospitalizations were studied in 383 myocardial infarction (MI) patients in relation to demographic, medical, and psychological factors. Short-term (i.e. within 6 months post-MI) utilization of physicians was only related to patients' health locus of control. In comparison, a higher number of physician consultations 3-5 years after the MI was independently related to female sex, more non-cardiac limitations before the MI, more complications during hospitalization, less cardiac lifestyle knowledge, and higher levels of anxiety and depression short time after the MI. Every second patient was readmitted to the hospital before the 3-5 years follow-up but only 14% suffered a non-fatal reinfarction. More rehospitalizations were independently related to a higher number of previous hospitalizations for heart disease, more pre-MI cardiac limitations, less cardiac lifestyle knowledge, and higher initial level of emotional distress. Discriminant analysis identified female sex and patients' initial expectations of reduced emotional control as the best predictor variables for a rehospitalization caused by chest pain without a new infarction, whereas a reinfarction was best discriminated by the number of previous hospitalizations for heart disease. We conclude that psychological factors influence health services utilization to a comparable extent as medical factors. These findings may indicate a greater need for long-term professional support in patients with less initial cognitive and emotional control.
在383例心肌梗死（MI）患者中，研究了短期和长期的医生会诊及再次住院情况，并分析了其与人口统计学、医学和心理因素的关系。短期（即MI后6个月内）的医生利用情况仅与患者的健康控制点有关。相比之下，MI后3至5年较高的医生会诊次数与女性性别、MI前更多的非心脏功能受限、住院期间更多的并发症、较少的心脏生活方式知识以及MI后短期内较高的焦虑和抑郁水平独立相关。在3至5年的随访前，每两名患者中就有一名再次住院，但只有14%的患者发生非致命性再梗死。更多的再次住院与既往因心脏病住院次数较多、MI前更多的心脏功能受限、较少的心脏生活方式知识以及更高的初始情绪困扰水平独立相关。判别分析确定，女性性别和患者最初对情绪控制降低的预期是无新梗死胸痛导致再次住院的最佳预测变量，而心脏病既往住院次数是再梗死的最佳判别变量。我们得出结论，心理因素对医疗服务利用的影响程度与医学因素相当。这些发现可能表明，对于初始认知和情绪控制较差的患者，更需要长期的专业支持。
