Institut de recherche et documentation en économie de la santé (IRDES), France.
Health Policy. 2018 Aug;122(8):908-914. doi: 10.1016/j.healthpol.2018.05.003. Epub 2018 May 18.
Rising numbers of visits to emergency departments (EDs), especially amongst the elderly, is a source of pressure on hospitals and on the healthcare system. This study aims to establish the determinants of ED visits in France at a territorial level with a focus on the impact of ambulatory care organisation on ED visits by older adults aged 65 years and over.
We use multilevel regressions to analyse how the organisation of healthcare provision at municipal and wider 'department' levels impacts ED utilisation by the elderly while controlling for the local demographic, socioeconomic and health context of the area in which patients live.
ED visits vary significantly by health context and economic level of municipalities. Controlling for demand-side factors, ED rates by the elderly are lower in areas where accessibility to primary care is high, measured as availability of primary care professionals, out-of-hours care and home visits in an area. Proximity (distance) and size of ED are drivers of ED use.
High rates of ED visits are partly linked to inadequate accessibility of health services provided in ambulatory settings. Redesigning ambulatory care at local level, in particular by improving accessibility and continuity of primary and social care services for older adults could reduce ED visits and, therefore, improve the efficient use of available healthcare resources.
急诊部（ED）就诊人数的增加，尤其是老年人，给医院和医疗系统带来了压力。本研究旨在从地域层面上确定法国 ED 就诊的决定因素，重点研究老年人（65 岁及以上）的门诊护理组织对 ED 就诊的影响。
我们使用多层次回归分析，研究在控制患者居住地区的当地人口、社会经济和健康背景等需求侧因素的情况下，市级和更广泛的“部门”级别的医疗服务提供组织如何影响老年人的 ED 利用率。
ED 就诊在卫生环境和市政经济水平方面存在显著差异。控制需求侧因素后，初级保健可及性高的地区（如初级保健专业人员的可用性、该地区的非工作时间医疗和上门医疗服务），老年人的 ED 就诊率较低。ED 的临近度（距离）和规模是 ED 使用的驱动因素。
高 ED 就诊率部分与门诊环境中提供的卫生服务可及性不足有关。在地方层面重新设计门诊护理，特别是通过改善老年人的初级保健和社会保健服务的可及性和连续性，可能会减少 ED 就诊，从而提高现有医疗资源的有效利用。
