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[基层医疗保健中心的频繁就诊者和急诊科的频繁就诊者]

[Frequent attenders in Primary Health Care Centres and frequent attenders in Emergency Departments].

作者信息

Fernández Alonso Cesáreo, Aguilar Mulet Juan Mariano, Romero Pareja Rodolfo, Rivas García Arístides, Fuentes Ferrer Manuel Enrique, González Armengol Juan Jorge

机构信息

Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España.

Servicio de Urgencias, Hospital La Princesa, Madrid, España.

出版信息

Aten Primaria. 2018 Apr;50(4):222-227. doi: 10.1016/j.aprim.2017.02.011. Epub 2017 Jun 10.

DOI:10.1016/j.aprim.2017.02.011
PMID:28610846
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6837134/
Abstract

OBJECTIVE

To identify predictors of frequent attenders (HF) in Primary Health Care (PHC) centres in a sample of frequent attenders (HF) in Emergency Departments (ED).

DESIGN

This was an observational, retrospective, multicentre cohort study.

PARTICIPANTS

The HF patients were selected from patients seen in the ED between January 1 and December 31, 2013. Setting Patients were recruited from 17 public hospitals of the Community of Madrid, Spain.

METHOD

Variables on the index visit to the ED were collected. The sample was analysed in terms of being or not being an HF user in PHC. An HF user is considered a patient who made at least 10 visits in each level of care for a year.

RESULTS

A total of 1284 HF patients were included. An analysis was performed on 423 (32.9%) HF users in ED with 16 (12-25) visits to PHC vs. 861 (67.1%) non-HF users in ED, with 4 (2-6) visits to PHC. Independent predictors of HF in PHC: over 65 years (OR: 1.51; 95% CI: 1.07-2.13; P=.019), cognitive impairment (OR: 1.63; 95% CI: 1.01-2.65; P=.049), taking >3 drugs (OR: 1.56; 95% CI: 1.06-2.30; P=.025), and living in the community vs. nursing home or homeless (OR: 3.05; 95% CI: 1.14-8.16; P=.026).

CONCLUSIONS

Among HF patients in the ED, the fact that of being over 65 years, taking 3or more drugs, suffering cognitive impairment, and living in the community, are also considered to be predictors of HF in PHC.

摘要

目的

在急诊科频繁就诊者(HF)样本中,确定初级卫生保健(PHC)中心频繁就诊者的预测因素。

设计

这是一项观察性、回顾性、多中心队列研究。

参与者

HF患者选自2013年1月1日至12月31日期间在急诊科就诊的患者。研究地点为西班牙马德里自治区的17家公立医院招募的患者。

方法

收集急诊首次就诊时的变量。根据是否为PHC中的HF使用者对样本进行分析。HF使用者被定义为每年在每个护理级别至少就诊10次的患者。

结果

共纳入1284例HF患者。对急诊科423例(32.9%)HF使用者进行了分析,这些患者在PHC就诊16次(12 - 25次),而急诊科861例(67.1%)非HF使用者在PHC就诊4次(2 - 6次)。PHC中HF的独立预测因素:年龄超过65岁(OR:1.51;95%CI:1.07 - 2.13;P = 0.019)、认知障碍(OR:1.63;95%CI:1.01 - 2.65;P = 0.049)、服用3种以上药物(OR:1.56;95%CI:1.06 - 2.30;P = 0.025),以及居住在社区与养老院或无家可归者相比(OR:3.05;95%CI:1.14 - 8.16;P = 0.026)。

结论

在急诊科HF患者中,年龄超过65岁、服用3种或更多药物、患有认知障碍以及居住在社区这几点,也被认为是PHC中HF的预测因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b3c/6837134/ce96815f3fec/fx1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b3c/6837134/ce96815f3fec/fx1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b3c/6837134/ce96815f3fec/fx1.jpg

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[Loyal frequent users of hospital emergency departments: the FIDUR project].[医院急诊科的忠实常客:FIDUR项目]
Emergencias. 2016 Feb;28(1):16-20.
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[Health care system sustainability and the contribution of emergency departments].[医疗保健系统的可持续性与急诊科的贡献]
Emergencias. 2015 Jun;27(3):197-203.
3
[Utility of the Identification of Seniors at Risk score to predict short-term adverse outcomes in elderly patients discharged from a short-stay unit].[识别高危老年人评分在预测短期住院病房出院老年患者短期不良结局中的效用]
我们可以将在急诊和初级保健中就诊次数最多的患者称为高频使用者。
Aten Primaria. 2019 Jan;51(1):50-51. doi: 10.1016/j.aprim.2018.05.008. Epub 2018 Oct 2.
4
[Could we call frequent attenders to patients because of their high frequency of attendance?].由于就诊频率高,我们能将这些频繁就诊者称为患者吗?
Aten Primaria. 2019 Jan;51(1):49-50. doi: 10.1016/j.aprim.2018.04.007. Epub 2018 Sep 29.
Emergencias. 2015 Jun;27(3):181-184.
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Is polypharmacy an independent risk factor for adverse outcomes after an emergency department visit?多重用药是否是急诊科就诊后不良结局的独立危险因素?
Intern Emerg Med. 2017 Mar;12(2):213-220. doi: 10.1007/s11739-016-1451-5. Epub 2016 Apr 13.
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[Frequent users of hospital emergency departments].[医院急诊科的频繁使用者]
Gac Sanit. 2015 Sep-Oct;29(5):394-6. doi: 10.1016/j.gaceta.2015.04.013. Epub 2015 Jun 4.
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Mortality, admission rates and outpatient use among frequent users of emergency departments: a systematic review.急诊科频繁使用者的死亡率、住院率和门诊使用率:一项系统综述。
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Identifying frequent users of emergency department resources.识别急诊科资源的频繁使用者。
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Frailty in elderly people.老年人虚弱。
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