Crafford Lize, Jenkins Louis S
Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, University of Stellenbosch.
Afr J Prim Health Care Fam Med. 2017 Jul 27;9(1):e1-e8. doi: 10.4102/phcfm.v9i1.1397.
The inappropriate use of emergency centres (ECs) is an expanding problem globally. The high attendance of non-urgent return presentations to ECs is recognised as part of the problem, placing an unnecessary demand on limited staff and resources. Of unscheduled returns 34% of cases had no change to diagnosis or treatment with the conclusion that 80% of re-attendance could be attributed to deficiencies in the initial consultation. This study aimed to evaluate the reasons why patients sought an early second consultation for the same complaint at a hospital EC in South Africa, by exploring the patient's experience and shortcomings in the first consultation.
A qualitative study was conducted using in-depth, semi-structured interviews with 20 purposively selected participants who presented to a rural regional provincial hospital's EC within 7 days of a prior consultation for the same complaint. Verbatim transcripts were analysed using the framework method.
The main reasons for a second consultation were symptom related factors and the need for diagnostic certainty. The major themes around patient experience of the initial consultation were shortcomings in effective evaluation and management of pain, diagnostic uncertainty including poor examination, poor explanation, uncertain access and follow-up and societal encouragement to utilise a hospital EC.
Further interventions should explore pain as a presenting symptom of the illness experience, and promote competence in addressing physical and psychological causative factors within a patient-centred approach for all health staff, especially in primary care services.
全球范围内，急诊中心（ECs）的不当使用问题日益严重。非紧急复诊患者大量涌入急诊中心被视为该问题的一部分，这对有限的医护人员和资源造成了不必要的压力。在非预约复诊病例中，34%的病例诊断或治疗无变化，研究得出结论，80%的再次就诊可归因于初次会诊存在缺陷。本研究旨在通过探究患者在初次会诊中的体验和不足，评估南非一家医院急诊中心患者就同一病症寻求早期二次会诊的原因。
采用定性研究方法，对20名有目的地选取的参与者进行深入的半结构化访谈，这些参与者在之前就同一病症进行会诊后的7天内前往一家农村地区省级医院的急诊中心就诊。采用框架法对逐字记录进行分析。
二次会诊的主要原因是与症状相关的因素以及确定诊断的需求。初次会诊患者体验的主要主题包括疼痛的有效评估和管理存在不足、诊断不确定性（包括检查不力、解释不当、就诊渠道和随访不确定）以及社会鼓励利用医院急诊中心。
进一步的干预措施应将疼痛视为疾病体验的一个表现症状，并以患者为中心的方法，提高所有医护人员，尤其是初级保健服务人员处理身体和心理致病因素的能力。
