Departments of Emergency and Acute Medicine, Campus Mitte and Virchow-Klinikum, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
German Coalition for Patient Safety (Aktionsbündnis Patientensicherheit), 10179 Berlin, Germany.
Int J Environ Res Public Health. 2022 May 17;19(10):6098. doi: 10.3390/ijerph19106098.
Mental health conditions are frequent among patients with somatic illnesses, such as cardiac diseases. They often remain undiagnosed and are related to increased utilization of outpatient services, including emergency department care. The objective of this qualitative study was to investigate the significance of the emergency department in the patients' course of treatment and from the physicians' perspective. An improved understanding of the subjective needs of this specific patient group should provide hints for targeted treatment. This study is part of the prospective EMASPOT study, which determined the prevalence of mental health conditions in emergency department patients with cardiac ambulatory care sensitive conditions. The study on hand is the qualitative part, in which 20 semi-structured interviews with patients and a focus group with six ED physicians were conducted. Data material was analyzed using the qualitative content analysis technique, a research method for systematically identifying themes or patterns. For interpretation, we used the "typical case approach". We identified five "typical patient cases" that differ in their cardiac and mental health burden of disease, frequency and significance of emergency department and outpatient care visits: (1) frequent emergency department users with cardiac diseases and mental health conditions, (2) frequent emergency department users without cardiac diseases but with mental health conditions, (3) needs-based emergency department users with cardiac diseases; (4) targeted emergency department users as an alternative to specialist care and (5) patients surprised by initial diagnose of cardiac disease in the emergency department. While patients often perceived the emergency department visit itself as a therapeutic benefit, emergency department physicians emphasized that frequent examinations of somatic complaints can worsen mental health conditions. To improve care, they proposed close cooperation with the patients' primary care providers, access to patients' medical data and early identification of mental health conditions after cardiac diagnoses, e.g., by an examination tool.
精神健康状况在患有躯体疾病（如心脏病）的患者中很常见。这些疾病往往未被诊断出来，并与增加门诊服务的利用有关，包括急诊护理。本定性研究的目的是从患者的治疗过程和医生的角度探讨急诊部门的重要性。更好地了解这一特定患者群体的主观需求应能为有针对性的治疗提供线索。本研究是前瞻性 EMASPOT 研究的一部分，该研究确定了具有心脏门诊治疗敏感条件的急诊患者中心理健康状况的患病率。本研究是定性部分，对 20 名患者进行了半结构化访谈，对 6 名急诊医生进行了焦点小组讨论。使用定性内容分析技术对数据材料进行了分析，这是一种系统识别主题或模式的研究方法。为了解释，我们使用了“典型案例方法”。我们确定了五个“典型患者案例”，这些案例在他们的心脏和心理健康疾病负担、急诊和门诊就诊的频率和重要性方面存在差异：（1）患有心脏病和精神健康状况的频繁急诊患者，（2）频繁急诊患者无心脏病但有精神健康状况，（3）基于需求的急诊患者有心脏病；（4）作为专科治疗替代的有针对性的急诊患者，（5）在急诊部门最初诊断为心脏病的患者感到惊讶。虽然患者通常认为急诊就诊本身具有治疗益处，但急诊医生强调，频繁检查躯体投诉会恶化精神健康状况。为了改善护理，他们建议与患者的初级保健提供者密切合作，获取患者的医疗数据，并在心脏病诊断后尽早识别精神健康状况，例如通过检查工具。
