Ateneo Center for Research and Innovation, Ateneo School of Medicine and Public Health, Pasig City, Philippines.
Department of Emergency Medicine, The Medical City, Pasig City, Philippines.
Emerg Med Australas. 2021 Apr;33(2):349-356. doi: 10.1111/1742-6723.13725. Epub 2021 Jan 19.
The non-standard emergency medicine services and the limited utilisation of primary care providers in the Philippines may contribute towards the ED being a preferred area for patients with non-urgent conditions. Our study aims to determine the factors associated with non-urgent consultations in the ED of a tertiary hospital in the Philippines.
From 7 January to 15 February 2020, we surveyed non-urgent ED patients (n = 757) presenting to a tertiary hospital in the Philippines. We evaluated the data using descriptive statistics, while chi-squared and multivariate analyses versus urgent ED patients (n = 281) were used to show the association of factors.
Our recruited non-urgent patients were mostly 21-40 years old (n = 576 [76%]), single (n = 437 [58%]), with full-time employment (n = 654 [86%]), have Health Maintenance Organization coverage (n = 684 [90%]), self-referred (n = 498 [66%]), and have private means of getting to ED (n = 414 [55%]). They had moderate scores of social support-seeking behaviours (mean 3.92/5; 95% confidence interval [CI] 3.88-3.96), health literacy (mean 3.58/5; 95% CI 3.56-3.61), self-efficacy (mean 3.09/5; 95% CI 3.56-3.61), whereas their ED access score (mean 4.10/5; 95% CI 4.06-4.14) was high. They had moderate self-assessed severity (mean 3.75/6; 95% CI 3.70-3.80), urgency (mean 3.83/6; 95% CI 3.78-3.88), and anxiety (mean 3.88/6; 95% CI 3.83-3.93) scores and high ED satisfaction rating (mean 4.73/6; 95% CI 4.69-4.77). They mostly had digestive (n = 203 [26.8%]) and infection-related (n = 172 [22.7%]) chief complaints and final diagnoses (n = 198 [26.2%] and n = 145 [19.2%], respectively), without previous consultations (n = 577 [76%]), and eventually discharged (n = 755 [99%]). Our urgent patients had similar characteristics, but with higher assessed patient severity, urgency, anxiety and satisfaction with ED services (P < 0.001).
Non-urgent consultations in ED are attributed to multiple factors encompassing socio-demographic, socio-economic and psychosocial dimensions. These factors must be considered in improving the current healthcare management system for the appropriate utilisation of ED in the Philippines.
菲律宾的非标准急诊医疗服务和初级保健提供者的利用有限，这可能导致急诊部成为非紧急病情患者的首选就诊地点。本研究旨在确定菲律宾一家三级医院急诊部非紧急就诊相关的因素。
2020 年 1 月 7 日至 2 月 15 日，我们调查了菲律宾一家三级医院的 757 名非紧急就诊的急诊患者。我们使用描述性统计数据评估数据，同时使用卡方检验和多变量分析将非紧急就诊患者（n=757）与紧急就诊患者（n=281）进行比较，以显示因素的关联。
我们招募的非紧急就诊患者主要为 21-40 岁（n=576[76%]）、单身（n=437[58%]）、全职工作（n=654[86%]）、有健康维护组织保险（n=684[90%]）、自行就诊（n=498[66%]）和使用私人交通工具到急诊部（n=414[55%]）。他们的社会支持寻求行为得分中等（平均 3.92/5；95%置信区间[CI] 3.88-3.96）、健康素养得分中等（平均 3.58/5；95% CI 3.56-3.61）、自我效能感得分中等（平均 3.09/5；95% CI 3.56-3.61），而他们的急诊部就诊得分较高（平均 4.10/5；95% CI 4.06-4.14）。他们的自我评估严重程度得分中等（平均 3.75/6；95% CI 3.70-3.80）、紧急程度得分中等（平均 3.83/6；95% CI 3.78-3.88）、焦虑程度得分中等（平均 3.88/6；95% CI 3.83-3.93），急诊满意度评分较高（平均 4.73/6；95% CI 4.69-4.77）。他们主要有消化系统（n=203[26.8%]）和感染相关的（n=172[22.7%]）主诉和最终诊断（n=198[26.2%]和 n=145[19.2%]），没有之前的就诊（n=577[76%]），最终出院（n=755[99%]）。我们的紧急就诊患者具有相似的特征，但患者严重程度、紧急程度、焦虑程度和对急诊服务的满意度评估较高（P<0.001）。
急诊部的非紧急就诊归因于多方面因素，包括社会人口学、社会经济和心理社会方面的因素。在菲律宾，为了适当利用急诊部，必须考虑这些因素，以改善当前的医疗保健管理系统。
