Egoda Kapuralalage Thilini Nisansala, Chan Ho Fai, Hughes James, Torgler Benno, Whyte Stephen
School of Economics and Finance, Queensland University of Technology, Brisbane, Queensland, Australia
School of Economics and Finance, Queensland University of Technology, Brisbane, Queensland, Australia.
BMJ Open. 2025 Apr 17;15(4):e090123. doi: 10.1136/bmjopen-2024-090123.
The aim of this exploratory study was to investigate the association between health anxiety and self-triage decisions among emergency department non-urgent patients.
Cross-sectional single-centre study SETTING: Emergency department in the Princess Alexandra Hospital in Brisbane, Australia PARTICIPANTS: Between 13 December 2022 and 30 August 2023, an exhaustive recruitment strategy was deployed to recruit 400 patients. Eligible participants were patients aged 18 years or above who belonged to the Australasian Triage Scale category four or five (non-urgent), were physically and mentally capable of participating in the study and presented to the emergency department between 6:00 a.m. and 23:00 p.m. during the study period.
The primary outcome was accurately self-triaged decisions, while the secondary outcome was inaccurately self-triaged decisions, including both overtriaged and undertriaged decisions. Self-triage decisions were assessed using six hypothetical medical scenarios.
Regression results revealed that health anxiety was not associated with accurately self-triaged decisions. However, compared with non-urgent patients exhibiting no health anxiety, those in the third and fourth quartiles (the upper two quartiles) of the Whiteley Index-6 were expected to make 0·29 (95% CI 0·09 to 0·50) and 0·25 (95% CI 0·07 to 0·44) more overtriaged decisions (mean=0·42; SD=0·71), respectively. In contrast, negative associations between health anxiety and undertriaged decisions were observed. Subgroup analyses by age showed statistically significant associations between health anxiety and inaccurately self-triaged decisions among the older adult patient group (aged 35-79 years). Moreover, analyses stratified by sex revealed that female and male patients in the fourth quartile of the Whiteley Index-6 were expected to make 0·26 (95% CI 0·02 to 0·49) and 0·27 (95% CI 0·05 to 0·48) more overtriaged decisions, respectively, compared with those with no health anxiety.
Our results suggest no significant association between health anxiety and accurately self-triaged decisions. In contrast, health anxiety was associated with inaccurately self-triaged decisions. This implies that patients with health anxiety overestimate the need for healthcare and therefore could substantially impact the misuse of health services, particularly emergency departments.
本探索性研究旨在调查急诊科非紧急患者的健康焦虑与自我分诊决策之间的关联。
横断面单中心研究
澳大利亚布里斯班亚历山德拉公主医院急诊科
在2022年12月13日至2023年8月30日期间，采用全面招募策略招募了400名患者。符合条件的参与者为年龄在18岁及以上、属于澳大利亚分诊量表四级或五级（非紧急）、身体和精神上有能力参与研究且在研究期间上午6:00至晚上23:00到急诊科就诊的患者。
主要结局是准确的自我分诊决策，次要结局是不准确的自我分诊决策，包括分诊过度和分诊不足的决策。使用六个假设医疗场景评估自我分诊决策。
回归结果显示，健康焦虑与准确的自我分诊决策无关。然而，与未表现出健康焦虑的非紧急患者相比，怀特利指数-6处于第三和第四四分位数（上两个四分位数）的患者预计分别会多做出0.29（95%CI 0.09至0.50）和0.25（95%CI 0.07至0.44）次分诊过度的决策（均值=0.42；标准差=0.71）。相反，观察到健康焦虑与分诊不足决策之间存在负相关。按年龄进行的亚组分析显示，在老年患者组（35 - 79岁）中，健康焦虑与不准确的自我分诊决策之间存在统计学上的显著关联。此外，按性别分层的分析显示，怀特利指数-6处于第四四分位数的女性和男性患者与无健康焦虑的患者相比，预计分别会多做出0.26（95%CI 0.02至0.49）和0.27（95%CI 0.05至0.48）次分诊过度的决策。
我们的结果表明，健康焦虑与准确的自我分诊决策之间无显著关联。相反，健康焦虑与不准确的自我分诊决策有关。这意味着患有健康焦虑的患者高估了对医疗保健的需求，因此可能会对医疗服务的滥用产生重大影响，尤其是急诊科。
