Redelmeier D A, Molin J P, Tibshirani R J
Department of Medicine, University of Toronto, Ontario, Canada.
Lancet. 1995 May 6;345(8958):1131-4. doi: 10.1016/s0140-6736(95)90975-3.
Homeless adults often visit emergency departments and often leave dissatisfied. We tested whether compassionate care, by improving patient satisfaction, can alter subsequent use of emergency services. We identified 133 consecutive homeless adults visiting one inner-city emergency department who were not acutely psychotic, extremely intoxicated, unable to speak English, or medically unstable. Half were randomly assigned to receive compassionate contact from trained volunteers. All patients otherwise had usual care and were followed for repeat visits to emergency departments. We found that rates of use were high, with patients making an average of seven visits a year (0.60 per month). More than a third of all patients made two or more visits within two days of each other. The average number of visits per month after intervention was significantly lower for patients who received compassionate care (0.43 vs 0.65, p = 0.018). Analyses adjusting for each patient's previous rate of use confirmed that compassionate care led to a one third reduction in the number of return visits within one month (95% CI 14 to 40%). Compassionate management of selected homeless adults decreases repeat visits to the emergency department. One explanation is that patients tend to return frequently until they are satisfied with their treatment.
无家可归的成年人经常前往急诊科就诊，且往往带着不满离开。我们测试了富有同情心的关怀能否通过提高患者满意度来改变后续急诊服务的使用情况。我们确定了连续133名前往某市中心急诊科就诊的无家可归成年人，他们没有急性精神病、极度醉酒、不会说英语或病情不稳定。其中一半被随机分配接受经过培训的志愿者的同情接触。所有患者均接受常规护理，并对其再次前往急诊科就诊的情况进行随访。我们发现就诊率很高，患者平均每年就诊7次（每月0.60次）。超过三分之一的患者在两天内就进行了两次或更多次就诊。接受同情关怀的患者在干预后每月的平均就诊次数显著更低（0.43对0.65，p = 0.018）。对每位患者之前的就诊率进行调整后的分析证实，同情关怀使一个月内的复诊次数减少了三分之一（95%置信区间为14%至40%）。对部分无家可归成年人进行同情管理可减少其再次前往急诊科就诊的次数。一种解释是，患者往往会频繁复诊，直到他们对治疗感到满意为止。
