Intensive Medicine and Emergencies CMU, Riotinto Hospital, Huelva,Spain.
Economy Department, University of Huelva, Huelva,Spain.
PLoS One. 2018 Nov 28;13(11):e0207199. doi: 10.1371/journal.pone.0207199. eCollection 2018.
To analyse the increase of self-referral patients at the Emergency Department of Riotinto District Hospital (in Huelva, Spain) during a short period. The study focused on patients' profiles to identify key factors that explained the increase of self-referrals.
Retrospective descriptive study using patient's data from a hospital emergency department between 2003-2015, excluding the period 2012-14 due to the lack of records. Socio-demographic variables, type of referral, access to health services, hospital route, transfer time and organisational changes were analysed, among other factors. Descriptive statistics, chi-square test, and binary logistic regression analysis were used.
Self-referral patients to the hospital emergency department revealed a growing trend. Logistic regression model showed that the variables that best predict its occurrence were the health system changes from 2008 and the time it takes to get to the Extra-hospital Emergency Services, where those changes act as modifiers of the effect. From 2008, the likelihood of self-referral in towns with an Extra-hospital Emergency Service over 2 minutes away by car was of 76.43%. When including the triage level, the logistic regression model showed that 83.1% of patients referred themselves.
Changes in the health system and in the time for patients to get to the reference hospital from their origin, affect the likelihood of self-referral to the emergency department. Once the patient's severity level was included, this variable, along with the time to get to the emergency department, modified the probability of self-referral to the emergency department. We found an increase in hospital services together with a reduction of resources in the primary care emergency system. This may have led to inefficiencies in the public health system, together with an increase in self-referrals and greater problems to service users.
分析雷蒂罗区医院（位于西班牙韦尔瓦）急诊科在短时间内自我转诊患者增加的情况。该研究侧重于患者特征，以确定解释自我转诊增加的关键因素。
使用 2003-2015 年期间医院急诊部患者的数据进行回顾性描述性研究，由于记录缺失，排除了 2012-14 年期间的数据。分析了社会人口统计学变量、转诊类型、获得卫生服务的途径、医院途径、转诊时间和组织变化等因素。使用描述性统计、卡方检验和二元逻辑回归分析。
医院急诊部自我转诊患者呈增长趋势。逻辑回归模型显示，预测其发生的最佳变量是 2008 年的卫生系统变化和到达医院外急诊服务的时间，这些变化是影响的修饰剂。自 2008 年以来，通过汽车前往外院急诊服务超过 2 分钟的城镇，自我转诊的可能性为 76.43%。当包括分诊级别时，逻辑回归模型显示 83.1%的患者自行转诊。
卫生系统的变化和患者从原籍地到达参考医院的时间，影响了急诊部自我转诊的可能性。一旦包括患者的严重程度，除了到达急诊部的时间外，该变量还改变了急诊部自我转诊的概率。我们发现医院服务增加，而初级保健急诊系统的资源减少。这可能导致公共卫生系统效率低下，自我转诊增加，服务使用者面临更大的问题。
