Runciman P, Currie C T, Nicol M, Green L, McKay V
Department of Health and Nursing, Queen Margaret College, Edinburgh, Scotland.
J Adv Nurs. 1996 Oct;24(4):711-8. doi: 10.1046/j.1365-2648.1996.02479.x.
Elderly people discharged directly home from an accident and emergency department are known to be a vulnerable group. The value of health visitor follow-up in patients aged 75 years and over was assessed in a random controlled trail; 222 intervention patients were seen at home by a research health visitor shortly after discharge and screened for new dependency and support needs, appropriate community services then being offered. These patients, and 192 controls for whom no special arrangements were made, were followed up four weeks later by a research occupational therapist. New dependency, most commonly trauma-related, was found in approximately 50%, and in the majority proved transient. Advice and/or referral to a wide range of services was offered to 92% of the intervention group. Service refusal rates were high in both groups. Compared to controls, intervention patients received more services and were significantly more independent at four weeks. Health visitor assessment was seen as helpful. In order to identify elderly accident and emergency department patients at risk following discharge, study data were used to derive a short questionnaire. In follow-up visits to 48 patients the use of this questionnaire was piloted, and its validity demonstrated. A number of study limitations and areas for development of discharge planning are discussed.
众所周知，从急诊部门直接出院回家的老年人是弱势群体。在一项随机对照试验中评估了健康访视员对75岁及以上患者进行随访的价值；222名干预患者在出院后不久由研究健康访视员进行家访，并筛查新出现的依赖和支持需求，然后提供适当的社区服务。这些患者以及192名未做特殊安排的对照组患者在四周后由研究职业治疗师进行随访。发现约50%的患者出现了新的依赖，大多数与创伤相关，且多数为短暂性。92%的干预组患者获得了广泛服务的建议和/或转介。两组的服务拒绝率都很高。与对照组相比，干预患者获得了更多服务，且在四周时明显更加独立。健康访视员的评估被认为是有帮助的。为了识别出院后有风险的老年急诊患者，研究数据被用于编制一份简短问卷。在对48名患者的随访中试用了这份问卷，并证明了其有效性。文中讨论了该研究的一些局限性以及出院计划的发展方向。
