Korczak Viola, Seimon Radhika, Bein Kendall, Jan Stephen, Lung Thomas, Dinh Michael
The George Institute for Global Health, University of New South Wales, Australia.
Emergency Department, Royal Prince Alfred Hospital, Camperdown, Australia.
Heliyon. 2024 Aug 30;10(17):e36520. doi: 10.1016/j.heliyon.2024.e36520. eCollection 2024 Sep 15.
To describe the clinical and longitudinal patterns of presentation, and to understand the underlying socioeconomic characteristics of different modes of presentation.
Retrospective state-wide data linkage analysis of emergency department (ED) presentations. Patients were included if they were 18 years of age or over and presented to the ED over twenty times within any consecutive 365-day period between January 2015 and December 2020. This analysis used routinely collected data from the Emergency Department Data Collection and Admitted Patient Data Collection. The quintile of Socioeconomic Indexes for Area (SEIFA) defined by Australian Bureau of Statistics was used for equity considerations.
The main outcomes of interest included patients' clinical presentation, demographic information and SEIFA score as represented by Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) quintiles.
There were 417,154 presentations and 5,244 patients who met the inclusion criteria. The majority of the presentations were from SEIFA groups 1 (28.2 %) and 2 (35.6 %). The most common presentations were for drug and alcohol (17.5 %), followed by abdominal pathology (11.8 %) and mental health (11.5 %). In the lowest SEIFA group, the main presenting complaints were for drug and alcohol and administrative presentations. While in the highest SEIFA group, the main presentations were for mental health then abdominal pain, followed by drug and alcohol presentations.
Patients in the lower SEIFA groups tended to be older with lower acuity presentations and were more likely to present to the same facility, more regularly. Patients in the lower SEIFA group were also more likely to present with drug and alcohol and administrative presentations while those in the higher SEIFA groups were more likely to present with mental health presentations. System wide interventions are needed to address the needs of both groups, particularly those from lower socioeconomic backgrounds, who would benefit from improved access to primary care either through access to General Practice or Urgent Care Centres.
描述临床表现及纵向模式，并了解不同就诊模式背后的社会经济特征。
对急诊科就诊情况进行全州范围的回顾性数据关联分析。纳入2015年1月至2020年12月期间，年龄在18岁及以上且在任何连续365天内到急诊科就诊超过20次的患者。本分析使用了急诊科数据收集和住院患者数据收集的常规收集数据。为了公平考虑，采用了澳大利亚统计局定义的地区社会经济指数（SEIFA）五分位数。
主要关注的结果包括患者的临床表现、人口统计学信息以及由相对社会经济优势和劣势指数（IRSAD）五分位数表示的SEIFA分数。
共有417,154次就诊，5244名患者符合纳入标准。大多数就诊患者来自SEIFA第1组（28.2%）和第2组（35.6%）。最常见的就诊原因是药物和酒精问题（17.5%），其次是腹部疾病（11.8%）和心理健康问题（11.5%）。在SEIFA最低组，主要就诊主诉是药物和酒精问题以及行政事务。而在SEIFA最高组中，主要就诊原因是心理健康问题，然后是腹痛，其次是药物和酒精问题。
SEIFA较低组的患者往往年龄较大，就诊时病情较轻，更有可能更频繁地前往同一医疗机构就诊。SEIFA较低组的患者也更有可能因药物和酒精问题以及行政事务就诊，而SEIFA较高组的患者更有可能因心理健康问题就诊。需要全系统的干预措施来满足这两组患者的需求，特别是那些社会经济背景较低的患者，他们将从通过全科医疗或紧急护理中心改善获得初级保健的机会中受益。
