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高估健康紧急程度是导致急诊服务不当使用的原因:葡萄牙探索性经济学实验的见解。

Overestimation of health urgency as a cause for emergency services inappropriate use: Insights from an exploratory economics experiment in Portugal.

机构信息

DEGEIT and GOVCOPP, University of Aveiro, Aveiro, Portugal.

JusGov, University of Minho, Braga, Portugal.

出版信息

Health Soc Care Community. 2019 Jul;27(4):1031-1041. doi: 10.1111/hsc.12720. Epub 2019 Feb 8.

Abstract

Increasing visits to emergency departments add strain to public healthcare systems. The misperception of symptoms' severity can partly explain inappropriate use of hospitals' emergency departments by non-urgent patients. This paper focuses on the misperception of symptoms' severity as a cause for the inappropriate use of emergency departments. It explores the role that informing potential patients of the correct severity level can play in correcting this inefficiency. We implement in an incentivised manner an exploratory economic experiment to elicit the degree of severity of five sets of symptoms, corresponding to frequent causes of emergency department visits. The study was setup in Braga, Northern Portugal, recruiting voluntary participants through civic local organisations. We ask participants to indicate the more suitable health service, before and after revealing the true degree of severity. Results show that there is an overestimation of the degree of severity of some clinical profiles, and when confronted with the real severity, in only half of the cases are choices changed to other health services. Although exploratory, this study provides insights into the potential role of health education policies concerning symptoms' severity but it also highlights the limits of such policies. Furthermore, the use of economic experiments can provide meaningful insights for the design of policies addressing demand-side healthcare inefficiencies.

摘要

急诊科就诊人次的增加给公共医疗体系带来了压力。人们对症状严重程度的误解部分解释了非紧急患者对医院急诊科的不适当使用。本文主要关注症状严重程度的误解是导致急诊科使用不当的原因之一。它探讨了告知潜在患者正确严重程度可以在纠正这种低效率方面发挥的作用。我们以激励的方式实施了一项探索性经济实验,以引出五组症状的严重程度,这些症状对应于急诊科就诊的常见原因。该研究在葡萄牙北部的布拉加进行,通过公民地方组织招募自愿参与者。我们要求参与者在揭示真实严重程度之前和之后,指出更合适的医疗服务。结果表明,一些临床特征的严重程度存在高估,并且在面对真实的严重程度时,只有一半的情况下选择会改变为其他医疗服务。尽管是探索性的,但这项研究提供了有关症状严重程度的健康教育政策的潜在作用的见解,但也突出了这些政策的局限性。此外,经济实验的使用可以为解决医疗需求方面的低效问题的政策设计提供有意义的见解。

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