Mustard C A, Kozyrskyj A L, Barer M L, Sheps S
Manitoba Centre for Health Policy and Evaluation, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg.
CMAJ. 1998 Jan 13;158(1):49-55.
(a) To describe the overall proportion of ambulatory care provided in emergency departments for a complete urban population, (b) to describe the variation across small geographic areas in the overall proportion of ambulatory care provided in emergency departments and (c) to identify attributes of small-area populations that are related to the provision of high proportions of total ambulatory care in emergency departments.
Cross-sectional ecologic study combining 4 sources of secondary data on health service utilization and socioeconomic status.
Winnipeg.
A total of 657,871 residents of metropolitan Winnipeg in the period April 1991 to March 1992, grouped into 112 neighbourhoods.
A proportion calculated, for each neighbourhood population, from the estimated count of emergency department visits divided by the population's use of total ambulatory care for a sample of 55 days in the study period.
The overall proportion of ambulatory care provided in emergency departments was 4.9% (range 2.6% to 10.8%), representing 35.5 emergency department visits per 100 person-years. Neighbourhoods with a higher proportion of total ambulatory care provided in emergency departments were characterized by lower mean household income, a higher proportion of emergency department visits for mental illness and a higher proportion of residents with treaty Indian status. Measures of need for medical care for were not consistently associated with the proportion of ambulatory care received in emergency departments.
In a health care system with an adequate supply of primary care physicians and universal insurance, this study has documented significant variation across small geographic areas in the proportion of total ambulatory care received in emergency departments. In the absence of strong evidence that this variation was associated with underlying need, the results suggest that attention be paid to the accessibility of conventional primary care.
(a) 描述急诊部门为整个城市人口提供的门诊护理的总体比例；(b) 描述急诊部门提供的门诊护理总体比例在小地理区域间的差异；(c) 确定与急诊部门提供高比例门诊护理总量相关的小区域人群特征。
结合关于卫生服务利用和社会经济地位的4个二手数据来源的横断面生态学研究。
温尼伯。
1991年4月至1992年3月期间，温尼伯市大都市地区的657871名居民，分为112个社区。
计算每个社区人群的比例，该比例通过将急诊就诊估计数除以研究期间55天样本中该人群的门诊护理总使用量得出。
急诊部门提供的门诊护理总体比例为4.9%（范围为2.6%至10.8%），相当于每100人年有35.5次急诊就诊。急诊部门提供的门诊护理总量比例较高的社区，其特征是平均家庭收入较低、精神疾病急诊就诊比例较高以及具有印第安条约身份的居民比例较高。医疗护理需求指标与急诊部门接受的门诊护理比例并非始终相关。
在一个有足够数量的初级保健医生且实行全民保险的医疗保健系统中，本研究记录了急诊部门接受的门诊护理总量比例在小地理区域间存在显著差异。在缺乏有力证据表明这种差异与潜在需求相关的情况下，研究结果表明应关注传统初级保健的可及性。
