Fernández Alonso Cesáreo, Aguilar Mulet Juan Mariano, Romero Pareja Rodolfo, Rivas García Arístides, Fuentes Ferrer Manuel Enrique, González Armengol Juan Jorge
Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España.
Servicio de Urgencias, Hospital La Princesa, Madrid, España.
Aten Primaria. 2018 Apr;50(4):222-227. doi: 10.1016/j.aprim.2017.02.011. Epub 2017 Jun 10.
To identify predictors of frequent attenders (HF) in Primary Health Care (PHC) centres in a sample of frequent attenders (HF) in Emergency Departments (ED).
This was an observational, retrospective, multicentre cohort study.
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.
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.
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).
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.
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。
这是一项观察性、回顾性、多中心队列研究。
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。
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。
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)。
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。