Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri.
Saint Louis University, Department of Health Management and Policy, 3545 Lafayette Ave, St Louis, MO 63104 (
Prev Chronic Dis. 2023 Sep 21;20:E82. doi: 10.5888/pcd20.230086.
Forty-seven percent of all adults in the US have a diagnosis of high blood pressure. Among all US emergency department (ED) users, an estimated 45% have high blood pressure. The success of high blood pressure interventions in reducing ED visits is partially predicated on patients' adherence to treatment plans. One method for promoting adherence to treatment plans is shared decision-making between patients and medical providers.
We conducted a cross-sectional observational study using 2015-2019 Medical Expenditure Panel Survey data. We used studies on shared decision-making as a guide to create a predictor variable for shared decision-making. We determined covariates according to the Andersen Behavioral Model of Health Services Use. ED use was the outcome variable. We used cross tabulation to compare covariates of ED use and multivariable logistical regression to assess the association between shared decision-making and ED use. Our sample size was 30,407 adults.
Less than half (39.3%) of respondents reported a high level of shared decision-making; 23.3% had 1 or more ED visits. In the unadjusted model, respondents who reported a high level of shared decision-making were 20% less likely than those with a low level of shared decision-making to report 1 or more ED visits (odds ratio [OR], 0.80; 95% CI, 0.75-0.86; P <.001). After adjusting for covariates, a high level of shared decision-making was still associated with lower odds of ED use (OR, 0.86; 95% CI, 0.76-0.97; P = .01).
Shared decision-making may be an effective method for reducing ED use among patients with high blood pressure.
美国 47%的成年人被诊断患有高血压。在美国所有急诊部 (ED) 用户中，估计有 45%患有高血压。高血压干预措施在减少 ED 就诊次数方面取得成功的部分原因是患者对治疗计划的依从性。促进患者对治疗计划的依从性的一种方法是患者与医疗提供者之间进行共同决策。
我们使用 2015-2019 年医疗支出面板调查数据进行了一项横断面观察性研究。我们使用关于共同决策的研究作为指南，创建了一个共同决策的预测变量。我们根据安德森健康服务使用行为模型确定了协变量。ED 使用是结果变量。我们使用交叉表比较 ED 使用的协变量，并使用多变量逻辑回归评估共同决策与 ED 使用之间的关联。我们的样本量为 30407 名成年人。
不到一半（39.3%）的受访者报告高水平的共同决策；23.3%的受访者有 1 次或多次 ED 就诊。在未调整模型中，报告高水平共同决策的受访者报告 1 次或多次 ED 就诊的可能性比报告低水平共同决策的受访者低 20%（优势比 [OR]，0.80；95%置信区间，0.75-0.86；P <.001）。在调整协变量后，高水平的共同决策仍然与 ED 使用的可能性降低相关（OR，0.86；95%置信区间，0.76-0.97；P =.01）。
共同决策可能是降低高血压患者 ED 使用的有效方法。
