Hudon Catherine, Sanche Steven, Haggerty Jeannie L
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada.
St Mary's Research Centre, St Mary's Hospital, Montréal, Québec, Canada.
PLoS One. 2016 Jun 14;11(6):e0157489. doi: 10.1371/journal.pone.0157489. eCollection 2016.
A small number of patients frequently using the emergency department (ED) account for a disproportionate amount of the total ED workload and are considered using this service inappropriately. The aim of this study was to identify prospectively personal characteristics and experience of organizational and relational dimensions of primary care that predict frequent use of ED.
This study was conducted among parallel cohorts of the general population and primary care patients (N = 1,769). The measures were at baseline (T1), 12 (T2) and 24 months (T3): self-administered questionnaire on current health, health behaviours and primary care experience in the previous year. Use of medical services was confirmed using administrative databases. Mixed effect logistic regression modeling identified characteristics predicting frequent ED utilization.
A higher likelihood of frequent ED utilization was predicted by lower socioeconomic status, higher disease burden, lower perceived organizational accessibility, higher number of reported healthcare coordination problems and not having a complete annual check-up, above and beyond adjustment for all independent variables.
Personal characteristics such as low socioeconomic status and high disease burden as well as experience of organizational dimensions of primary care such as low accessibility, high healthcare coordination problems and low comprehensiveness of care are prospectively associated with frequent ED utilization. Interventions developed to prevent inappropriate ED visits, such as case management for example, should tailor low socioeconomic status and patients with high disease burden and should aim to improve experience of primary care regarding accessibility, coordination and comprehensiveness.
少数频繁使用急诊科（ED）的患者占急诊科总工作量的比例过高，被认为不恰当地使用了这项服务。本研究的目的是前瞻性地确定预测频繁使用急诊科的个人特征以及初级保健组织和关系维度方面的经历。
本研究在普通人群和初级保健患者的平行队列中进行（N = 1769）。测量在基线（T1）、12个月（T2）和24个月（T3）进行：关于当前健康状况、健康行为和前一年初级保健经历的自填问卷。使用行政数据库确认医疗服务的使用情况。混合效应逻辑回归模型确定了预测频繁使用急诊科的特征。
除了对所有自变量进行调整外，社会经济地位较低、疾病负担较重、感知到的组织可及性较低、报告的医疗协调问题较多以及未进行全面年度体检，预测频繁使用急诊科的可能性更高。
社会经济地位低和疾病负担重等个人特征，以及初级保健组织维度方面的经历，如可及性低、医疗协调问题多和护理全面性低，与频繁使用急诊科前瞻性相关。为防止不适当的急诊科就诊而开展的干预措施，例如病例管理，应针对社会经济地位低和疾病负担重的患者，并应旨在改善初级保健在可及性、协调性和全面性方面的体验。
