Iserson K V, Kastre T Y
Arizona Bioethics Program, University of Arizona College of Medicine, Tucson 85724, USA.
Am J Emerg Med. 1996 Jan;14(1):1-5. doi: 10.1016/S0735-6757(96)90001-7.
This study was designed to quantify the willingness of emergency departments (EDs) and private care practitioners to see medically indigent patients. Three case scenarios were developed to represent severe, moderate, and mild problems that typically confront ED physicians. A female investigator made telephone calls using these scenarios, each time declaring herself to be medically indigent. All EDs received calls about all three scenarios, but only the least severe scenario was used for private practitioners. The timing and order of all calls were randomized. A control survey of the same population was subsequently performed in which the caller related that she had third-party insurance and had the minimal (rash) problem. The participants were all 54 nonmilitary EDs in Arizona and 69 randomly chosen private primary care practitioners in the same locales as the EDs. Calls to EDs were made during all time periods and days of the week; private practitioners were called only during their weekday office hours. The majority of all EDs were willing to see medically indigent patients, recommending that the caller come to the ED immediately 76% of the time. This response did not vary by geography or the facility's size, although ED personnel suggested initial home treatment more commonly at smaller hospitals (P = .02), and suggested coming to the ED more often on weekends (P < .02). Some EDs, however, clearly did not comply with their own telephone advice policies, and some ED personnel failed to give medically appropriate advice. In contrast to the EDs (P < .001), 62% of private practitioners' staffs stated they were not taking new patients or required at least $30 in advance. Private practitioners in the largest communities were significantly more reluctant to see the medically indigent than their peers in smaller communities (P < .05). For an insured caller, 55% of private practitioners would see the caller for < $30 and only 35% were not taking new patients or provided referral. In contrast to most private primary care practitioners, EDs are at least willing to serve as a triage point for the medically indigent and are often the primary-care "safety net" for the medically indigent.
本研究旨在量化急诊科和私人执业医生接待医疗贫困患者的意愿。设计了三种病例场景，分别代表急诊科医生通常会遇到的严重、中度和轻度问题。一名女性调查员根据这些场景打电话，每次都自称是医疗贫困患者。所有急诊科都接到了关于这三种场景的电话，但只有最不严重的场景用于联系私人执业医生。所有电话的时间和顺序都是随机的。随后对相同人群进行了一项对照调查，调查中打电话者称自己有第三方保险，且有轻微（皮疹）问题。研究对象包括亚利桑那州的54家非军队急诊科以及与这些急诊科位于同一地区的69名随机挑选的私人初级保健医生。给急诊科打电话的时间是一周中的所有时段和日子；给私人执业医生打电话的时间仅为工作日的办公时间。大多数急诊科愿意接待医疗贫困患者，76%的情况下会建议打电话者立即前往急诊科。这种反应不受地理位置或医疗机构规模的影响，不过在规模较小的医院，急诊科工作人员更常建议患者先在家中治疗（P = 0.02），且在周末建议患者前往急诊科的频率更高（P < 0.02）。然而，一些急诊科显然未遵守其自身的电话咨询政策，一些急诊科工作人员也未给出符合医学规范的建议。与急诊科相比（P < 0.001），62%的私人执业医生的工作人员表示他们不接收新患者或要求提前至少支付30美元。最大社区的私人执业医生比小社区的同行明显更不愿意接待医疗贫困患者（P < 0.05）。对于有保险的打电话者，55%的私人执业医生会以低于30美元的费用接待患者，只有35%的医生不接收新患者或提供转诊。与大多数私人初级保健医生不同，急诊科至少愿意作为医疗贫困患者的分诊点，并且常常是医疗贫困患者的初级保健“安全网”。
