Ellbrant Julia, Åkeson Jonas, Eckner Jenny, Karlsland Åkeson Pia
Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, SE-20502, Malmö, Sweden.
Department of Clinical Sciences Malmö, Surgery, Lund University, Skåne University Hospital, Jan Waldenströms gata 11 A, SE-20502, Malmö, Sweden.
BMC Emerg Med. 2018 Dec 27;18(1):59. doi: 10.1186/s12873-018-0210-5.
Parental social characteristics influence the use of emergency departments (ED) in the USA, but less is known about paediatric ED care-seeking in countries with national health insurance. This prospective study was designed to evaluate associations between parental care-seeking and social characteristics, with emphasis on impact of non-native origin, at a paediatric ED in Sweden, a European country providing paediatric healthcare free of charge.
Parents attending a paediatric ED at a large urban university hospital filled out a questionnaire on social characteristics and reasons for care-seeking. Information on patient characteristics and initial management was obtained from ED registers and patient records. Paediatric ED physicians assessed the medical appropriateness of each patient visit triaged for ED care.
In total, 962 patient visits were included. Telephone healthline service before the paediatric ED visit was less often used by non-native parents (63/345 vs. 249/544, p < 0.001). Low-aquity visits, triaged away from the ED, were more common among non-native parents (80/368 vs. 67/555, OR = 1.66; p = 0.018), and among those reporting lower abilities in the Swedish language (23/82 vs. 120/837, OR = 2.66; p = 0.003). Children of non-native parents were more often assessed by physicians not to require ED care (122/335 vs. 261/512, OR = 0.70; p = 0.028).
This study confirms more direct and less urgent use of paediatric ED care by parents of non-native origin or with limited abilities in the Swedish language, proposing that parental social characteristics influence paediatric ED care-seeking, also in a country with healthcare free of charge, and that specific needs of these groups should be better met by prehospital medical services.
在美国，父母的社会特征会影响急诊部门（ED）的使用情况，但对于拥有国家医疗保险的国家中儿童前往急诊部门就诊的情况，我们了解得较少。这项前瞻性研究旨在评估瑞典一家儿科急诊部门中父母寻求医疗服务与社会特征之间的关联，重点关注非本地出身的影响。瑞典是一个提供免费儿科医疗服务的欧洲国家。
在一家大型城市大学医院的儿科急诊部门就诊的父母填写了一份关于社会特征和寻求医疗服务原因的问卷。从急诊登记册和患者记录中获取患者特征和初始治疗的信息。儿科急诊医生评估了分诊到急诊部门接受治疗的每位患者就诊的医疗适宜性。
总共纳入了962次患者就诊。非本地父母在儿科急诊就诊前较少使用电话健康热线服务（63/345对249/544，p<0.001）。被分诊离开急诊部门的低公平性就诊在非本地父母中更为常见（80/368对67/555，OR=1.66；p=0.018），在那些报告瑞典语能力较低的父母中也更为常见（23/82对120/837，OR=2.66；p=0.003）。非本地父母的孩子更常被医生评估为不需要急诊治疗（122/335对261/512，OR=0.70；p=0.028）。
本研究证实，非本地出身或瑞典语能力有限的父母对儿科急诊服务的使用更直接且不太紧急，这表明父母的社会特征也会影响在一个提供免费医疗服务的国家中儿童前往急诊部门就诊的情况，并且这些群体的特殊需求应由院前医疗服务更好地满足。
