Springer Adelle M, Condon John R, Li Shu Q, Guthridge Steven L
Health Gains Planning Branch, Northern Territory Department of Health, PO Box 40596, Casuarina, NT, 0811, Australia.
Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia.
BMC Health Serv Res. 2017 May 12;17(1):348. doi: 10.1186/s12913-017-2285-1.
Frequent use (FU) of hospital services impacts on patients and health service expenditure. Studies examining FU in emergency departments and inpatient settings have found heterogeneity and the need to differentiate between potentially preventable FU and that associated with ongoing management of complex conditions. Psychosocial factors have often been reported as underpinning or exacerbating the phenomena. Most FU studies have been limited by time, to a single study site, or restricted to specific diagnoses or patient groups. This study provides a comprehensive description of adult patient characteristics, conditions and risk factors associated with FU, based on admissions to the five public hospitals in the Northern Territory (NT) of Australia over a nine year period. The study population is distinctive comprising both Aboriginal and non-Aboriginal patients.
Data on all inpatient episodes in NT public hospitals between 2005 and 2013 was analysed to identify patients with any FU (four or more episodes within any 12-month period) and measure FU duration (number of FU years) and intensity (mean number of episodes per FU year). Pregnancy, alcohol-related and mental health condition flags were assigned to patients with any episode with relevant diagnoses during the study period. Multivariate analysis was used to assess factors associated with any FU, FU duration and FU intensity, separately for Aboriginal and non-Aboriginal patients.
Of people with any inpatient episodes during the study period, 13.6% were frequent users (Aboriginal 22%, non-Aboriginal 10%) accounting for 46.6% of all episodes. 73% of frequent users had only one FU year. Any FU and increased FU duration were more common among individuals who were: Aboriginal; older; female; and those with a pregnancy, alcohol or mental health flag. Having two or more alcohol-related episodes in the nine-year period was strongly associated with any FU for both Aboriginal (odds ratio 8.9, 95% CI. 8.20-9.66) and non-Aboriginal patients (11.5, 9.92-13.26).
For many people, frequent inpatient treatment is necessary and unavoidable. This study suggests that damage arising from excessive alcohol consumption (either personal or by others) is the single most avoidable factor associated with FU, particularly for Aboriginal people.
频繁使用医院服务会对患者和卫生服务支出产生影响。在急诊科和住院环境中对频繁使用情况的研究发现存在异质性，并且需要区分潜在可预防的频繁使用情况与与复杂病情持续管理相关的情况。心理社会因素经常被报道为这些现象的基础或加剧因素。大多数频繁使用情况研究受到时间限制，局限于单一研究地点，或限于特定诊断或患者群体。本研究基于澳大利亚北领地（NT）五家公立医院九年期间的入院情况，全面描述了与频繁使用相关的成年患者特征、病情和危险因素。研究人群具有独特性，包括原住民和非原住民患者。
分析2005年至2013年北领地公立医院所有住院病例的数据，以识别有任何频繁使用情况（任何12个月期间内四次或更多次住院）的患者，并测量频繁使用持续时间（频繁使用年数）和强度（每年频繁使用的平均次数）。在研究期间，为有任何相关诊断住院的患者分配妊娠、酒精相关和心理健康状况标记。采用多变量分析分别评估原住民和非原住民患者中与任何频繁使用情况、频繁使用持续时间和频繁使用强度相关的因素。
在研究期间有任何住院病例的人群中，13.6%为频繁使用者（原住民占22%，非原住民占10%），占所有住院病例的46.6%。73%的频繁使用者仅有一年频繁使用情况。任何频繁使用情况和更长的频繁使用持续时间在以下人群中更为常见：原住民；年龄较大者；女性；以及有妊娠、酒精或心理健康标记的人。在九年期间有两次或更多次酒精相关住院病例与原住民（比值比8.9，95%置信区间8.20 - 9.66）和非原住民患者（11.5，9.92 - 13.26）的任何频繁使用情况都密切相关。
对许多人来说，频繁住院治疗是必要且不可避免的。本研究表明，过度饮酒（个人或他人）造成的损害是与频繁使用相关的最可避免的单一因素，尤其是对原住民而言。
