社会经济剥夺影响骨科门诊预约的未就诊情况以及医疗保健的可及性和参与度：一项队列研究。
Socioeconomic Deprivation Influences Failure to Attend Arranged Orthopaedic Outpatient Appointments as Well as Access to and Engagement With Health Care: A Cohort Study.
作者信息
Badial V, Turner S F, Jeffrey H, Barter R, Hayter E, Anakwe R E
机构信息
Department of Trauma and Orthopaedic Surgery, St Mary's Hospital.
Imperial College, London.
出版信息
JB JS Open Access. 2025 May 8;10(2). doi: 10.2106/JBJS.OA.24.00238. eCollection 2025 Apr-Jun.
BACKGROUND
We undertook this study to examine the "did-not-attend" (DNA) rate for the orthopaedic outpatient clinic at a large tertiary center, to understand the influencing factors and reasons from the patient perspective and to determine the impact of socioeconomic deprivation.
METHODS
We reviewed all scheduled outpatient attendances to our trauma and orthopaedic surgery service over a 12-month period and demographic information for each patient, including the Index of Multiple Deprivation. We studied the rate and predictors for nonattendance in the outpatient clinic and the influence of socioeconomic deprivation. We undertook a secondary study to evaluate the reasons patients gave for nonattendance, their perception of the accessibility, usefulness, and format of the outpatient model and any relationship with socioeconomic deprivation.
RESULTS
Eighteen thousand thirty-three patients attended 58,396 outpatient appointments over the 12-month study period. 2060 patients "did not attend" at least one arranged orthopaedic outpatient appointment over the 12 months of the study period. Men and more socioeconomically deprived patients were more likely to not attend. The most common reasons given for not attending were that patients did not feel that the appointment was useful for them. Patients from socioeconomically deprived groups were more likely to reference transport difficulties as a reason for not attending (p < 0.001). Socioeconomically deprived and disadvantaged patients reported poorer satisfaction scores regarding how able they felt to access orthopaedic help and services when they needed to and how able they felt to access orthopaedic help and services in a way that suits them.
CONCLUSIONS
Socioeconomic deprivation affects health and access to health care. Patients who are more socioeconomically deprived are more likely to not attend, and they report poorer satisfaction with access to orthopaedic outpatient care. DNA rates may reflect underlying health disparities.
LEVEL OF EVIDENCE
Level II. See Instructions for Authors for a complete description of levels of evidence.
背景
我们开展这项研究，旨在调查一家大型三级医疗中心骨科门诊的“未就诊”（DNA）率，从患者角度了解影响因素及原因，并确定社会经济剥夺的影响。
方法
我们回顾了创伤与骨科手术服务在12个月期间所有预约门诊就诊情况以及每位患者的人口统计学信息，包括多重剥夺指数。我们研究了门诊未就诊率及预测因素，以及社会经济剥夺的影响。我们进行了一项二次研究，以评估患者给出的未就诊原因、他们对门诊模式的可及性、有用性和形式的看法，以及与社会经济剥夺的任何关系。
结果
在为期12个月的研究期间，18033名患者进行了58396次门诊预约。在研究期间的12个月里，有2060名患者“未就诊”至少一次安排好的骨科门诊预约。男性以及社会经济剥夺程度较高的患者更有可能未就诊。未就诊的最常见原因是患者认为预约对他们没用。社会经济剥夺群体的患者更有可能将交通困难作为未就诊的原因（p<0.001）。社会经济剥夺和处境不利的患者报告称，在他们需要时获得骨科帮助和服务的能力以及以适合他们的方式获得骨科帮助和服务的能力方面，满意度得分较低。
结论
社会经济剥夺影响健康和医疗服务的可及性。社会经济剥夺程度较高的患者更有可能未就诊，并且他们对获得骨科门诊护理的满意度较低。未就诊率可能反映了潜在的健康差异。
证据水平
二级。有关证据水平的完整描述，请参阅作者指南。
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