Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany.
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine Campus Mitte and Virchow, Charitéplatz 1, Berlin, 10117, Germany.
BMC Health Serv Res. 2022 Feb 10;22(1):169. doi: 10.1186/s12913-022-07591-5.
Only few studies of emergency department (ED) consulters include a longitudinal investigation. The EMACROSS study had surveyed 472 respiratory patients in eight inner-city EDs in Berlin in 2017/2018 for demographic, medical and consultation-related characteristics. This paper presents the results of a follow-up survey at a median of 95 days post-discharge. We aimed to explore the post hoc assessment of ED care and identify potential longitudinal trends.
The follow-up survey included items on satisfaction with care received, benefit from the ED visit, potential alternative care, health care utilization, mental and general health, and general life satisfaction. Univariable between-subject and within-subject statistical comparisons were conducted. Logistic regression was performed for multivariable investigations of determinants of dropout and of retrospectively rating the ED visit as beneficial.
Follow-up data was available for 329 patients. Participants of lower education status, migrants, and tourists were more likely to drop out. Having a general practitioner (GP), multimorbidity, and higher general life satisfaction were determinants of response. Retrospective satisfaction ratings were high with no marked longitudinal changes and waiting times as the most frequent reason for dissatisfaction. Retrospective assessment of the visit as beneficial was positively associated with male sex, diagnoses of pneumonia and respiratory failure, and self-referral. Concerning primary care as a viable alternative, judgment at the time of the ED visit and at follow-up did not differ significantly. Health care utilization post-discharge increased for GPs and pulmonologists. Self-reported general health and PHQ-4 anxiety scores were significantly improved at follow-up, while general life satisfaction for the overall sample was unchanged.
Most patients retrospectively assess the ED visit as satisfactory and beneficial. Possible sex differences in perception of care and its outcomes should be further investigated. Conceivable efforts at diversion of ED utilizers to primary care should consider patients' views regarding acceptable alternatives, which appear relatively independent of situational factors. Representativeness of results is restricted by the study focus on respiratory symptoms, the limited sample size, and the attrition rate.
German Clinical Trials Register ( DRKS00011930 ); date: 2017/04/25.
只有少数急诊科（ED）顾问的研究包括纵向调查。EMACROSS 研究在 2017/2018 年期间调查了柏林 8 家市中心 ED 的 472 名呼吸患者，以了解人口统计学、医疗和咨询相关特征。本文介绍了中位数为 95 天出院后的随访调查结果。我们旨在探讨 ED 护理的事后评估，并确定潜在的纵向趋势。
随访调查包括对所接受护理的满意度、从 ED 就诊中获益、潜在的替代护理、卫生保健利用、精神和一般健康以及一般生活满意度的评估。进行了单变量组间和组内统计比较。进行了多变量分析，以确定辍学的决定因素和回顾性评估 ED 就诊是否有益。
329 名患者提供了随访数据。教育程度较低、移民和游客更有可能中途退出。有全科医生（GP）、合并症和较高的一般生活满意度是反应的决定因素。回顾性满意度评分较高，没有明显的纵向变化，等待时间是最常见的不满原因。回顾性评估就诊有益与男性、肺炎和呼吸衰竭诊断以及自我转诊呈正相关。关于初级保健作为可行的替代方案，ED 就诊时和随访时的判断没有显著差异。出院后对全科医生和肺科医生的卫生保健利用率增加。自我报告的一般健康和 PHQ-4 焦虑评分在随访时显著改善，而总体样本的一般生活满意度保持不变。
大多数患者回顾性地评估 ED 就诊是满意和有益的。护理和结果的感知可能存在性别差异，应进一步调查。为将 ED 利用者分流至初级保健而进行的可能努力应考虑患者对可接受替代方案的看法，这些看法似乎相对独立于情境因素。结果的代表性受到研究重点关注呼吸症状、样本量有限和失访率的限制。
德国临床试验注册处（DRKS00011930）；日期：2017 年 4 月 25 日。
