1 Anaesthesiology and Intensive Care Medicine, Skåne University Hospital, Malmö, Sweden.
2 Paediatrics, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
Scand J Public Health. 2018 Jun;46(4):456-462. doi: 10.1177/1403494817735222. Epub 2017 Oct 10.
Direct seeking of care at paediatric emergency departments may result from an inadequate awareness or a short supply of medical alternatives. We therefore evaluated the care-seeking patterns, availability of medical options and initial medical assessments - with overall reference to socioeconomic status - of parents at an urban paediatric emergency department in a Scandinavian country providing free paediatric healthcare.
The parents of children assessed by paediatric emergency department physicians at a Swedish university hospital over a 25-day winter period completed a questionnaire on recent medical contacts and their reasons for attendance. Additional information was obtained from ledgers, patient records and population demographics.
In total, 657 of 713 eligible patients (92%) were included. Seventy-nine per cent of their parents either failed to or managed to establish medical contact before the emergency department visit, whereas 21% sought care with no attempt at recent medical contact. Visits with a failed telephone or primary care contact (18%) were more common outside office hours ( p=0.014) and were scored as less urgent ( p=0.014). A perceived emergency was the main reason for no attempt at medical contact before the visit. Direct emergency department care-seeking was more common from the city district with the lowest socioeconomic status ( p=0.027).
Although most parents in this Swedish study tried to seek medical advice before attending a paediatric emergency department, perceived emergency, a short supply of telephone health line or primary care facilities and lower socioeconomic status contributed to direct care-seeking by almost 40% of parents. Pre-hospital awareness and the availability of medical alternatives with an emphasis on major differences in socioeconomic status should therefore be considered to further optimize care-seeking in paediatric emergency departments.
直接到儿科急诊就诊可能是由于对医疗替代方案的认识不足或供应不足。因此，我们评估了在斯堪的纳维亚国家的一个城市儿科急诊就诊的父母的就诊模式、医疗选择的可用性和初步医疗评估 - 总体上参考社会经济地位。
在瑞典一家大学医院的儿科急诊医生评估的儿童的父母在 25 天的冬季期间完成了一份关于最近医疗接触及其就诊原因的问卷。从分类帐、患者记录和人口统计数据中获得了其他信息。
共有 713 名符合条件的患者中的 657 名（92%）被纳入研究。他们的父母中有 79%要么未能或设法在急诊就诊前建立医疗联系，而 21%的人在没有最近医疗接触的情况下寻求医疗服务。在非办公时间（p=0.014），与电话或初级保健联系失败的就诊（18%）更为常见，并且评分较低（p=0.014）。就诊前未尝试医疗联系的主要原因是认为存在紧急情况。直接到急诊就诊的情况在社会经济地位最低的城市区更为常见（p=0.027）。
尽管在这项瑞典研究中，大多数父母在就诊前试图寻求医疗建议，但认为紧急情况、电话健康热线或初级保健设施供应不足以及社会经济地位较低导致近 40%的父母直接寻求医疗服务。因此，应考虑在就诊前的意识和医疗替代方案的可用性，重点关注社会经济地位的重大差异，以进一步优化儿科急诊就诊。
