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[患者自行前往急诊科的动机——一项前瞻性单中心观察性研究]

[Motives of patients presenting independently at the emergency department-a prospective monocentric observational study].

作者信息

Sitter Katharina, Braunstein Mareen, Wörnle Markus

机构信息

Klinik für Neurologie der Universität Regensburg am medbo Bezirksklinikum Regensburg, Universitätsstr. 84, 93053, Regensburg, Deutschland.

Zentrale Notaufnahme, Klinikum Innenstadt, LMU Klinikum, Ludwig-Maximilians-Universität München, Ziemssenstraße 5, 80336, München, Deutschland.

出版信息

Med Klin Intensivmed Notfmed. 2024 Oct;119(7):546-557. doi: 10.1007/s00063-024-01106-2. Epub 2024 Jan 17.

Abstract

BACKGROUND

In the ongoing professional, societal, and political discussion, the hypothesis is repeatedly put forward that a large portion of patients who independently visit the emergency department could also be treated in other care settings such as by a general practitioner, the statutory medical on-call service, or in emergency clinics. Various reasons are cited for why these alternative care settings are not utilized in these cases.

OBJECTIVES

This study investigates the motives of patients who presented independently at the emergency department, as well as the socio-demographic parameters of this study cohort.

MATERIALS AND METHODS

The survey was carried out as part of a prospective monocentric observational study of internal medicine patients at a university emergency department.

RESULTS

A total of 1086 patients were included in the study. In total, 33% of the study participants visited the emergency department based on a physician's recommendation or referral instead of opting for an alternative care option. The main reason for visiting the emergency department was the subjectively assessed urgency of their symptoms. Among the patients who presented independently at the emergency department, 28% required further inpatient care during the course of treatment. Awareness of alternative care pathways, such as utilizing emergency medical services, seeking care from the statutory medical on-call service, or visiting an emergency clinic, was low.

CONCLUSIONS

Emergency departments remain an important point of contact for patients who present there independently, without being brought by emergency medical services. The motives behind why patients choose a visit to the emergency department over treatment in an alternative care setting vary. If alternatives are to be used instead of emergency departments, structures first need to be established or expanded.

摘要

背景

在当前专业、社会和政治层面的讨论中,反复有人提出一种假设,即很大一部分自行前往急诊科的患者也可以在其他医疗环境中接受治疗,比如由全科医生、法定医疗值班服务机构或急诊诊所进行治疗。针对为何在这些情况下未利用这些替代医疗环境,人们列举了各种原因。

目的

本研究调查自行前往急诊科的患者的动机,以及该研究队列的社会人口统计学参数。

材料与方法

该调查是作为对一所大学急诊科内科患者进行的前瞻性单中心观察性研究的一部分开展的。

结果

共有1086名患者纳入本研究。总体而言,33%的研究参与者是基于医生的建议或转诊而前往急诊科,而非选择其他替代医疗选项。前往急诊科的主要原因是患者主观评估的症状紧急程度。在自行前往急诊科的患者中,28%在治疗过程中需要进一步住院治疗。对替代医疗途径的认知度较低,比如利用紧急医疗服务、寻求法定医疗值班服务机构的治疗或前往急诊诊所。

结论

急诊科仍然是那些未由紧急医疗服务机构送来、而是自行前往的患者的重要接触点。患者选择前往急诊科而非在替代医疗环境中接受治疗背后的动机各不相同。如果要使用替代医疗环境而非急诊科,首先需要建立或扩大相应的体系。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e84c/11461550/b50cc32e4301/63_2024_1106_Fig1_HTML.jpg

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