作为一个潜在的机会，以促进初级保健的参与和改变利用模式 - 在德国柏林的一项试点研究的结果。

Emergency department visits as a potential opportunity to promote primary care attachment and modify utilization patterns - results of a pilot study in Berlin, Germany.

机构信息

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, Augustenburger Platz 1, 13353, Berlin, Germany.

出版信息

BMC Emerg Med. 2024 Aug 7;24(1):142. doi: 10.1186/s12873-024-01056-0.

DOI:10.1186/s12873-024-01056-0

PMID:39112973

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11304799/

Abstract

BACKGROUND

Utilization by low acuity patients contributes to emergency department (ED) crowding. Both knowledge deficits about adequate care levels and access barriers in primary care are important promoters of such presentations. Concurrently, not having a general practitioner (GP) increases the likelihood of low-acuity ED utilization. This pilot study thus investigated feasibility, acceptance, and potential effects of an ED-delivered intervention for low-acuity patients with no regular primary care provider, consisting of an educational leaflet on acute care options and an optional GP appointment scheduling service.

METHODS

Low-acuity ED consulters not attached to a GP were given an information leaflet about alternative care offers for acute health problems and offered optional personal appointment scheduling at a local GP practice. Patients were surveyed on demographics, medical characteristics, health care utilization, valuation of the intervention, and reasons for not being attached to a GP and visiting the ED. A follow-up survey was conducted after twelve months. Trends in health and health care utilization were evaluated.

RESULTS

Between December 2020 and April 2022, n = 160 patients were enrolled, n = 114 were followed up. The study population was characterized by young age (mean 30.6 years) and predominantly good general health. Besides good health, personal mobility was a central reason for not being attached to a GP, but general preference for specialists and bad experiences with primary care were also mentioned. Most frequently stated motives for the ED consultation were subjective distress and anxiety, a belief in the superiority of the hospital, and access problems in primary care. The interventional offers were favorably valued, 52.5% (n = 84) accepted the GP appointment scheduling service offer. At follow-up, GP utilization had significantly increased, while there were no significant changes regarding utilization of other providers, including ED. An additional practice survey showed a 63.0% take-up rate for the appointment service.

CONCLUSIONS

With this pilot study, we were able to show that a personalized appointment scheduling service seems to be a promising approach to promote GP attachment and increase primary care utilization in patients without a regular GP in a highly urbanized setting. Further larger-scale studies are needed to investigate potential quantitative effects on ED visits.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS00023480); date 2020/11/27.

摘要

背景

低 acuity 患者的就诊会导致急诊部门（ED）拥堵。对适当治疗水平的知识不足以及初级保健中的准入障碍是导致这种情况的重要因素。同时，没有全科医生（GP）会增加低 acuity ED 就诊的可能性。因此，这项试点研究调查了一种针对没有常规初级保健提供者的低 acuity ED 患者的 ED 提供的干预措施的可行性、可接受性和潜在效果，该干预措施包括一份有关急性护理选择的教育传单和可选的 GP 预约安排服务。

方法

未与 GP 挂钩的低 acuity ED 顾问会收到一份关于急性健康问题的替代治疗方案的信息传单，并提供在当地 GP 诊所预约个人就诊的机会。患者接受了关于人口统计学、医疗特征、医疗保健利用、对干预措施的评价以及未与 GP 挂钩并前往 ED 的原因的调查。在 12 个月后进行了随访调查。评估了健康和医疗保健利用的趋势。

结果

在 2020 年 12 月至 2022 年 4 月期间，共招募了 160 名患者，其中 114 名患者进行了随访。研究人群的特点是年龄较小（平均 30.6 岁），且普遍健康状况良好。除了健康状况良好之外，个人移动能力也是未与 GP 挂钩的主要原因，但也提到了对专科医生的普遍偏好和对初级保健的不良体验。最常提到的 ED 就诊原因是主观不适和焦虑、对医院优越性的信念以及初级保健准入问题。干预措施的提供得到了积极评价，52.5%（n=84）接受了 GP 预约安排服务的邀请。在随访时，GP 的利用率显著增加，而其他提供者（包括 ED）的利用率没有显著变化。另外一项实践调查显示，预约服务的使用率为 63.0%。