Department of Emergency Medicine, University of Ottawa, Ottawa, ON.
CJEM. 2019 Sep;21(5):659-666. doi: 10.1017/cem.2019.376.
Our objective was to determine emergency department (ED) patient adherence to outpatient specialized geriatric services (SGS) following ED evaluation by the geriatric emergency management (GEM) nurse, and identify barriers and facilitators to attendance.
We conducted a prospective cohort study at two academic EDs between July and December 2016, enrolling a convenience sample of patients ≥ 65 years, seen by a GEM nurse, referred to outpatient SGS, and consented to study participation. We completed a chart review and a structured telephone follow-up at 6 weeks. Descriptive statistics were used.
We enrolled 103/285 eligible patients (86 eligible but not enrolled, 86 declined specialized geriatric referrals, and 10 declined study participation). Patients were mean age of 83.1 years, 59.2% female, and 73.2% cognitively impaired. Reasons for referral included mobility (86.4%), cognition (56.3%), pain (38.8%), mood (35.0%), medications (33.0%), and nutrition (31.1%). Referrals were to Geriatric Day Hospital (GDH) programs (50.5%), geriatric outreach (26.2%), falls clinic (12.6%), and geriatric psychiatry (8.7%). Adherence with follow-up was 59.2%. Barriers to attendance included patient did not feel SGS were needed (52.1%), inability to recall GEM consultation (53.4%), and dependence on family for transportation (72.6%). Home-based assessments had the highest adherence (81.5%).
Adherence of older ED patients referred by the GEM team to SGS is suboptimal, and a large proportion of patients decline these referrals in the ED. Future work should examine the efficacy of home-based assessments in a larger confirmatory setting and focus on interventions to increase referral acceptance and address barriers to attendance.
本研究旨在确定在老年急诊管理（GEM）护士对急诊科（ED）进行评估后，ED 患者对老年专科服务（SGS）的门诊随访依从性，并识别就诊的障碍和促进因素。
我们在 2016 年 7 月至 12 月期间在两家学术 ED 进行了一项前瞻性队列研究，纳入了方便抽样的年龄≥65 岁、接受过 GEM 护士评估、被转介至 SGS 门诊且同意参与研究的患者。我们在 6 周时完成了病历回顾和结构化电话随访。使用描述性统计分析。
我们共纳入了 285 名符合条件的患者中的 103 名（86 名符合条件但未纳入研究，86 名拒绝专科老年转介，10 名拒绝参与研究）。患者的平均年龄为 83.1 岁，59.2%为女性，73.2%认知受损。转介的原因包括活动能力（86.4%）、认知功能（56.3%）、疼痛（38.8%）、情绪（35.0%）、药物（33.0%）和营养（31.1%）。转介至老年日间医院（GDH）项目（50.5%）、老年外联（26.2%）、跌倒诊所（12.6%）和老年精神病学（8.7%）。随访的依从性为 59.2%。就诊的障碍包括患者认为不需要 SGS（52.1%）、无法回忆 GEM 咨询（53.4%）以及依赖家庭提供交通（72.6%）。家庭评估的依从性最高（81.5%）。
由 GEM 团队转介至 SGS 的老年 ED 患者的依从性不理想，很大一部分患者在 ED 拒绝这些转介。未来的研究应在更大的验证性环境中检验家庭评估的效果，并专注于提高转介接受率和解决就诊障碍的干预措施。
