Grumbach K, Keane D, Bindman A
Department of Family and Community Medicine, San Francisco General Hospital, CA 94110.
Am J Public Health. 1993 Mar;83(3):372-8. doi: 10.2105/ajph.83.3.372.
Our objective was to evaluate whether referral to primary care settings would be clinically appropriate for and acceptable to patients waiting for emergency department care for nonemergency conditions.
We studied 700 patients waiting for emergency department care at a public hospital. Access to alternative sources of medical care, clinical appropriateness of emergency department use, and patients' willingness to use nonemergency services were measured and compared between patients with and without a regular source of care.
Nearly half (45%) of the patients cited access barriers to primary care as their reason for using the emergency department. Only 13% of the patients waiting for care had conditions that were clinically appropriate for emergency department services. Patients with a regular source of care used the emergency department more appropriately than did patients without a regular source of care. Thirty-eight percent of the patients expressed a willingness to trade their emergency department visit for an appointment with a physician within 3 days.
Public emergency departments could refer large numbers of patients to appointments at primary care facilities. This alternative would be viable only if the availability and coordination of primary care services were enhanced for low-income populations.
我们的目的是评估对于因非紧急情况而等待急诊科治疗的患者，转诊至基层医疗服务机构在临床上是否合适以及患者是否能够接受。
我们研究了一家公立医院中700名等待急诊科治疗的患者。测量并比较了有和没有固定医疗服务来源的患者获得其他医疗服务来源的情况、急诊科使用的临床适宜性以及患者使用非紧急服务的意愿。
近一半（45%）的患者将基层医疗服务的获取障碍作为他们使用急诊科的原因。等待治疗的患者中只有13%的病情在临床上适合急诊科服务。有固定医疗服务来源的患者比没有固定医疗服务来源的患者更合理地使用急诊科。38%的患者表示愿意用他们的急诊科就诊机会换取在3天内与医生的预约。
公立急诊科可以将大量患者转诊至基层医疗设施进行预约。只有在为低收入人群加强基层医疗服务的可及性和协调性的情况下，这种替代方案才可行。
