高血压患者就诊于急诊的轨迹。

Trajectory of patients consulting the emergency department for high blood pressure values.

机构信息

Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada.

Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.

出版信息

CJEM. 2022 Aug;24(5):515-519. doi: 10.1007/s43678-022-00307-y. Epub 2022 May 3.

DOI:10.1007/s43678-022-00307-y

PMID:35503402

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9345802/

Abstract

OBJECTIVES

Emergency department (ED) visits for high blood pressure are increasing in frequency. We aimed to map those patients' trajectory, from referral sources to the type of care received at the ED to anticipated actions for future high blood pressure concerns, and to better understand their reasons for consulting the ED for high blood pressure values.

METHODS

Between 2018 and 2020, patients who presented to the Montreal Heart Institute's ED for elevated blood pressure were recruited in a prospective observational study including a post hoc structured telephone interview and medical chart review. Five possible referral sources were predetermined. We provided proportions and 95% confidence intervals.

RESULTS

A total of 100 patients were recruited (female: 59%, mean age: 69 ± 12). A majority (93%, 95% CI 88-98%) possessed a home blood pressure device, among which 46% (95% CI 36-56%) remembered receiving advice for its use. The main referral sources for high blood pressure to the ED were self-reference (53%, 95% CI 43-63%), advice of a lay person (19%, 95% CI 11-27%) or a nurse (13%, 95% CI 6-20%). Mainly, patients reported being concerned by concomitant symptoms or experiencing acute medical consequences (44%, 95% CI 34-54%), having followed the recommendation of a third party (33%, 95% CI 24-42%), or having concerns about their medication (6%, 95% CI 1-11%). Two weeks following their ED visits, consulting ED remained the main choice for future concerns about high blood pressure for 27% of participants. When specifically asked if they would return to the ED for elevated blood pressure, 73% (95% CI 64-83%) said yes.

CONCLUSIONS

Most patients who consulted the ED for elevated blood pressure values were self-referred. More can be done to promote blood pressure education, effective use of personal blood pressure devices, and recommendations for patients and health professionals when confronted with high blood pressure results.

摘要

目的

高血压患者到急诊科就诊的频率正在增加。我们旨在绘制这些患者的轨迹，从转介来源到急诊科接受的护理类型，再到未来高血压相关问题的预期治疗措施，以更好地了解他们因高血压就诊的原因。

方法

在 2018 年至 2020 年期间，因高血压就诊于蒙特利尔心脏研究所急诊科的患者参与了一项前瞻性观察研究，包括事后的结构化电话访谈和病历回顾。预先确定了五个可能的转介来源。我们提供了比例及其 95%置信区间。

结果

共招募了 100 名患者（女性占 59%，平均年龄 69±12 岁）。大多数患者（93%，95%CI 88-98%）拥有家用血压计，其中 46%（95%CI 36-56%）记得接受过使用建议。高血压患者到急诊科就诊的主要转介来源是自我转介（53%，95%CI 43-63%）、非专业人士的建议（19%，95%CI 11-27%）或护士（13%，95%CI 6-20%）。主要原因是患者因并发症状或出现急性医疗后果而感到担忧（44%，95%CI 34-54%），或听从了第三方的建议（33%，95%CI 24-42%），或对自己的药物治疗感到担忧（6%，95%CI 1-11%）。在急诊科就诊两周后，27%的患者仍将急诊科作为未来高血压问题的主要选择。当被具体问及是否会因血压升高再次到急诊科就诊时，73%（95%CI 64-83%）的患者表示会。