Savira Feby, Frith Madison, Aditya Clarissa J, Randall Sean, White Naomi, Giddy Andrew, Spark Lauren, Swann Jamie, Robinson Suzanne
Institute for Health Transformation, Deakin University, Melbourne, VIC.
Western Victoria Primary Health Network, Ballarat, VIC.
Med J Aust. 2025 May 19;222(9):450-461. doi: 10.5694/mja2.52663. Epub 2025 May 1.
To identify published studies that examined the impact of urgent care centres on the numbers of presentations to emergency departments (EDs), or explored the experiences and views of patients and practitioners regarding urgent care centres as alternative sources of health care and advice.
Scoping review of qualitative and quantitative studies published to 28 August 2024.
MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, and CINAHL databases; grey literature searches.
Of 2698 potentially relevant publications, 51 met our inclusion criteria (30 quantitative studies; 21 qualitative studies). Urgent care centres of various types were led by general practitioners in 41 of 51 studies, primarily managed people with non-urgent conditions or minor illnesses in 34 studies and non-emergency but urgent conditions in eight, and nine of the 22 studies that discussed funding indicated that access to the centres was free of charge. The effect of urgent care centres on ED presentation numbers was mixed; all seven studies of after-hours clinics, one of two studies of 24-hour clinics, and four of five studies of walk-in centres reported reduced ED visit numbers; in eleven studies that reported effects on hospital admissions from the ED, they were lower in seven (studies of an urgent cancer care centre, four community health centres, and a general practitioner cooperative). Patient satisfaction with urgent care centres is generally as high as with other primary care services; they preferred them to EDs, and preferred personal triage to telephone triage. Reasons for people choosing urgent care centres included easier access and the unavailability of doctors or appointments elsewhere. Clinicians reported increased workload, mixed experiences with the coordination of care, concerns about unregistered or undocumented people using the services, and protocol confusion, particularly with respect to triage. Continuity of care was a concern for both clinicians and patients.
Urgent care centres, especially walk-in and after-hours clinics, can help reduce the number of ED presentations and reduce health care costs. Patient satisfaction with such clinics is high, but public health education could guide people to appropriate care for non-urgent health problems. Training in the management of conditions frequently seen in urgent care centres is needed to ensure consistent, effective care.
识别已发表的研究,这些研究考察了紧急护理中心对急诊科就诊人数的影响,或探讨了患者及从业者对紧急护理中心作为替代医疗保健和建议来源的体验与看法。
对截至2024年8月28日发表的定性和定量研究进行范围综述。
MEDLINE、Embase、Cochrane对照试验中央注册库(CENTRAL)、PsycINFO和CINAHL数据库;灰色文献检索。
在2698篇潜在相关出版物中,51篇符合我们的纳入标准(30篇定量研究;21篇定性研究)。在51项研究中的41项里,各类紧急护理中心由全科医生领导;34项研究主要管理非紧急状况或轻症患者,8项研究管理非急诊但紧急的状况;在22项讨论资金的研究中,9项表明使用这些中心是免费的。紧急护理中心对急诊科就诊人数的影响不一;所有7项关于非工作时间诊所的研究、2项24小时诊所研究中的1项,以及5项即时诊疗中心研究中的4项均报告称急诊科就诊人数减少;在11项报告对急诊科住院人数有影响的研究中,7项研究显示住院人数减少(一项紧急癌症护理中心研究、4项社区健康中心研究和一项全科医生合作研究)。患者对紧急护理中心的满意度通常与其他初级保健服务一样高;他们更喜欢紧急护理中心而非急诊科,并且更喜欢面对面分诊而非电话分诊。人们选择紧急护理中心的原因包括就诊更便捷以及其他地方无法预约到医生。临床医生报告工作量增加,在护理协调方面体验不一,担心未登记或无记录的人员使用服务,以及存在诊疗流程混乱的情况,尤其是在分诊方面。护理的连续性是临床医生和患者都关心的问题。
紧急护理中心,尤其是即时诊疗中心和非工作时间诊所,有助于减少急诊科就诊人数并降低医疗成本。患者对这类诊所的满意度较高,但公共卫生教育可引导人们针对非紧急健康问题选择合适的护理方式。需要对紧急护理中心常见病症的管理进行培训,以确保提供持续、有效的护理。