Bone L R, Mamon J, Levine D M, Walrath J M, Nanda J, Gurley H T, Noji E K, Ward E
Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205.
Am J Emerg Med. 1989 Jan;7(1):16-20. doi: 10.1016/0735-6757(89)90077-6.
This study introduced trained paraprofessionals, community health workers (CHWs), into the emergency department (ED) to supplement providers' routine efforts in high blood pressure (HBP) detection, treatment, and follow-up among high-risk black men. In a demonstration project over a 2-year period, CHWs provided (1) BP and pulse measurements, and educational counseling regarding HBP and cardiovascular risk factors; (2) telephone preappointment reminders to improve ED follow-up visit rates; and (3) recontact of patients failing to show for their ED follow-up visits to improve return rates even after missed BP appointments. Results of preappointment reminders by CHWs showed a 19% improvement in appointment keeping (P less than .001). With a sample of patients who had failed to return for a follow-up visit, CHW contact was also effective, showing an overall improvement rate of 7% (P less than .001). The results reported support the idea that individuals from the community, trained as paraprofessionals, can improve appointment keeping as well as be useful in assisting in screening and counseling for chronic conditions within the ED. These CHWs are seen as having the additional advantage of enhancing the integration of the ED, the community, and continuing care sites. The approaches used in this study should be applicable and may serve as a model for the approach to other chronic conditions experienced in urban high-risk communities.
本研究将经过培训的非专业人员，即社区卫生工作者（CHW）引入急诊科（ED），以补充医护人员在高危黑人男性高血压（HBP）检测、治疗及随访方面的常规工作。在一项为期两年的示范项目中，社区卫生工作者提供了以下服务：（1）测量血压和脉搏，并就高血压及心血管危险因素提供教育咨询；（2）通过电话进行预约前提醒，以提高急诊科随访就诊率；（3）重新联系未按预约前来急诊科进行随访就诊的患者，即使在错过血压检查预约后，也能提高复诊率。社区卫生工作者进行预约前提醒的结果显示，预约遵守率提高了19%（P<0.001）。对于未前来复诊的患者样本，社区卫生工作者的联系也很有效，总体改善率为7%（P<0.001）。报告的结果支持这样一种观点，即接受过非专业人员培训的社区成员可以提高预约遵守率，并且有助于在急诊科进行慢性病筛查和咨询。这些社区卫生工作者被认为还有一个额外的优势，即能够加强急诊科、社区和持续护理机构之间的整合。本研究中使用的方法应该具有适用性，并且可以作为处理城市高危社区中其他慢性病的方法的一个范例。
