Department of Family Medicine, McGill University, Montreal, Québec, Canada.
École de réadaptation, Université de Sherbrooke, Québec, Canada.
Public Health. 2019 Jul;172:1-7. doi: 10.1016/j.puhe.2019.03.024. Epub 2019 May 23.
Frequent users of healthcare services are a small proportion of patients with disproportionately high healthcare usage. A wide array of factors, including psychological distress, leads to frequent use of healthcare services. There is no existing synthesis of research on frequent use and psychological distress in the general population. This scoping review aimed to compare psychological distress between frequent and non-frequent users and to examine the association between psychological distress and frequent use of healthcare services in primary care and emergency department (ED) services.
A scoping review was performed following the five steps defined by Arksey and O'Malley. A search strategy was developed with an information specialist in five databases (Medline, PsycINFO, CINAHL, SCOPUS, and PubMed) for articles in English published between 1963 and October 2018. To be included, studies had to be quantitative, have taken place in a primary care or ED setting, have documented frequent use, and have measured psychological distress in patients. Two team members independently gathered the data for each of the included studies. Results were collated, summarized, and reported using narrative synthesis.
Seven studies met the inclusion criteria. Psychological distress in primary care is generally higher in frequent users, and increased psychological distress scores are associated with frequent use. Both studies set in EDs reported noteworthy findings, stating that frequent users reported higher levels of psychological distress and that psychological distress was associated with frequent use.
Psychological distress is prevalent in frequent users and has a significant association with frequent use. As such, psychological distress should be evaluated by physicians to prevent or reduce frequent use and to identify candidates for interventions.
高频次使用医疗服务的患者在患者群体中占比较小，但他们的医疗服务使用量却很高。大量的因素，包括心理困扰，导致了高频次使用医疗服务的情况。目前，尚未有针对普通人群中高频次使用医疗服务和心理困扰的综合研究。本范围界定综述旨在比较高频次使用者和非高频次使用者之间的心理困扰，并研究初级保健和急诊部门（ED）服务中，心理困扰与高频次使用医疗服务之间的关系。
我们按照 Arksey 和 O'Malley 定义的五个步骤进行了范围界定综述。我们与一名信息专家合作制定了一个搜索策略，在五个数据库（Medline、PsycINFO、CINAHL、SCOPUS 和 PubMed）中搜索了 1963 年至 2018 年 10 月期间发表的英文文章。纳入标准为：定量研究、发生在初级保健或 ED 环境中、记录高频次使用、在患者中测量心理困扰的研究。两名团队成员独立收集了每一项纳入研究的数据。结果使用叙述性综合进行了整理、总结和报告。
有 7 项研究符合纳入标准。初级保健中的高频次使用者的心理困扰通常更高，并且心理困扰评分的增加与高频次使用相关。两个在 ED 中进行的研究报告了值得注意的发现，即高频次使用者报告了更高水平的心理困扰，并且心理困扰与高频次使用相关。
心理困扰在高频次使用者中很普遍，并且与高频次使用有显著关联。因此，医生应该评估心理困扰，以预防或减少高频次使用，并识别干预的候选人。
