Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
BMJ Open. 2021 Nov 24;11(11):e053110. doi: 10.1136/bmjopen-2021-053110.
Aim of this study was to analyse if subjectively perceived treatment urgency of patients in emergency departments is associated with self-reported health literacy and the willingness to use the general practitioner (GP) as coordinator of treatment.
A multicentre, cross-sectional, observational study.
Emergency departments in five hospitals. Each hospital was visited 14 times representing two 8-hour shifts on each day of the week. Calendar dates were randomly assigned.
All patients of legal age registered at the emergency department or hospital reception desk. Exclusion criteria included immediate or very urgent need of treatment, high level of symptom burden and severe functional impairments in terms of hearing, vision and speech. We conducted standardised personal interviews. Additionally, clinical data were extracted from patient records.
Our target variable was subjectively perceived treatment urgency. Predictor variables included age, sex, education, health-related quality of life (EuroQol Five-Dimension Scale, value set UK), anxiety and depression (Hospital Anxiety and Depression Scale), somatic symptoms (Patient Health Questionnaire, 15 items version), self-reported health literacy (European Health Literacy Questionnaire, 16 questions version) and the commitment to the GP (Fragebogen zur Intensität der Hausarztbindung, 'F-HaBi'). Data were analysed by multilevel, multivariable linear regression adjusted for random effects at the hospital level.
Our sample comprised 276 patients with a mean age of 50.1 years and 51.8% women. A low treatment urgency (defined as 0-5 points on a Numerical Rating Scale) was reported by 111 patients (40.2%). In the final model, lower subjective treatment urgency was associated with male sex (β=0.84; 95% CI 0.11/1.57, p=0.024), higher health-related quality of life (-2.27 to -3.39/-1.15, p<0.001), lower somatic symptoms score (0.09, 0.004/0.17, p=0.040), higher anxiety score (-0.13 to -0.24/-0.01, p=0.027) and lower commitment to the GP (0.08, 0.01/0.14, p=0.029).
A lower level of subjectively perceived treatment urgency was predicted by a lower willingness to use the GP as coordinator of treatment. Self-reported health literacy did not predict the patients' urgency rating.
本研究旨在分析急诊科患者主观感知的治疗紧迫性是否与自我报告的健康素养以及愿意将全科医生（GP）作为治疗协调者相关。
多中心、横断面、观察性研究。
五家医院的急诊科。每家医院各进行 14 次访问，每周每天进行两次 8 小时轮班。日历日期随机分配。
在急诊科或医院接待处登记的所有法定年龄的患者。排除标准包括立即或非常需要治疗、症状负担高和听力、视力和言语严重功能障碍。我们进行了标准化的个人访谈。此外，还从患者记录中提取了临床数据。
我们的目标变量是主观感知的治疗紧迫性。预测变量包括年龄、性别、教育程度、健康相关生活质量（欧洲五维健康量表，英国值集）、焦虑和抑郁（医院焦虑和抑郁量表）、躯体症状（患者健康问卷，15 项版本）、自我报告的健康素养（欧洲健康素养问卷，16 题版本）和对全科医生的承诺（Fragebogen zur Intensität der Hausarztbindung，'F-HaBi'）。数据通过多水平、多变量线性回归进行分析，并调整了医院水平的随机效应。
我们的样本包括 276 名平均年龄为 50.1 岁、51.8%为女性的患者。111 名患者（40.2%）报告治疗紧迫性较低（数字评分量表 0-5 分）。在最终模型中，较低的主观治疗紧迫性与男性（β=0.84；95%CI 0.11/1.57，p=0.024）、较高的健康相关生活质量（-2.27 至-3.39/-1.15，p<0.001）、较低的躯体症状评分（0.09，0.004/0.17，p=0.040）、较高的焦虑评分（-0.13 至-0.24/-0.01，p=0.027）和较低的对全科医生的承诺（0.08，0.01/0.14，p=0.029）相关。
较低的主观治疗紧迫性预测了患者对使用全科医生作为治疗协调者的意愿较低。自我报告的健康素养并不能预测患者的紧急程度评分。
