Bolíbar I, Balanzó X, Armada A, Fernández J L, Foz G, Sanz E, de la Torre M
Institut de Recerca Epidemiològíca i Clínica (IREC), Serveis de Prevenció Assistencials i Sòcio-Sanitaris (PASS), Mataró, Barcelona.
Med Clin (Barc). 1996 Sep 14;107(8):289-95.
The overutilization of the hospital emergency areas (HEA) in recent years has been related to an inadequate functioning of the primary health care and can be corrected by the implementation of the primary health care reform.
Home interview of a sample of residents of the city of Mataró (Barcelona, Spain), where the primary health care reform affects to four of the seven basic health areas. Collection of information on health care utilization and attitudes to its use.
Of the 1,974 studied subjects 27% (CI 95%, 25-29) reported to have used the HEA in the former year, and the frequency of visits was 0.48 (CI 95%, 0.44-0.54) per person. For the 1880 beneficiaries of the national health system, these results were somewhat lower between the users of reformed centres (27%, 0.46) than those of non-reformed centres (30%, 0.50) (p = NS); differences were attributed mainly to adult women. Users of reformed centres expressed more preference for the ambulatory in case of a non-severe emergency (37% and 17%; p < 0.0001) and consulted more often before going to the HEA (17 and 10%; p = 0.03). Among the reasons to go to the HEA, users of the reformed model perceived less necessity of an immediate action (43 and 52%; p = 0.05) and greater time barriers with the basic health areas (23 and 15%; p = 0.04).
In spite of the lack of overall differences in the use of HEA between users of reformed centres and non-reformed centres we observed a lower utilization in some age and sex groups from reformed centres. Some elements of the demand of the HEA are more appropriate and attributed to the primary health care reform. However, the reasons prompting to use the HEA show that an unjustified utilization is still done, independently of the primary health care model.
近年来医院急诊区域（HEA）的过度使用与初级卫生保健功能不完善有关，可通过实施初级卫生保健改革加以纠正。
对西班牙巴塞罗那马塔罗市的部分居民进行入户访谈，初级卫生保健改革涉及该市七个基本卫生区域中的四个。收集医疗保健利用情况及使用态度的信息。
在1974名研究对象中，27%（95%置信区间，25 - 29）报告上一年使用过HEA，人均就诊频率为0.48（95%置信区间，0.44 - 0.54）。对于1880名国家卫生系统受益人，改革中心的使用者（27%，0.46）与未改革中心的使用者（30%，0.50）相比，这些结果略低（p = 无统计学意义）；差异主要归因于成年女性。改革中心的使用者在非严重急诊情况下对门诊的偏好更高（37%和17%；p < 0.0001），前往HEA之前咨询的频率更高（17%和10%；p = 0.03）。在前往HEA的原因中，改革模式的使用者认为立即行动的必要性较低（43%和52%；p = 0.05），与基本卫生区域的时间障碍更大（23%和15%；p = 0.04）。
尽管改革中心和未改革中心的使用者在HEA使用方面总体上没有差异，但我们观察到改革中心某些年龄和性别的人群利用率较低。HEA需求的一些因素更合适，并归因于初级卫生保健改革。然而，促使使用HEA的原因表明，无论初级卫生保健模式如何，仍存在不合理的使用情况。
