Béland F, Lemay A, Boucher M
GRIS, Faculté de médecine, Université de Montréal, Que., Canada.
Soc Sci Med. 1998 Jul;47(2):165-79. doi: 10.1016/s0277-9536(98)00029-x.
What are the functions of hospital emergency care in our society? How are these functions associated with the characteristics of emergency room users, their environment and with other available medical resources? To answer these questions, an ecological conceptual framework has been developed, along with a procedure which clearly distinguishes between the sources of individual variation (user characteristics) and ecological variation (the users' environment and available medical resources). Four different functions have been identified: (1) care of critical or urgent cases requiring treatment only available in a hospital, (2) care of urgent cases requiring treatment also available elsewhere than in a hospital, (3) care of non-urgent cases requiring treatment only available in a hospital and (4) care of non-urgent cases requiring treatment also available elsewhere than in a hospital. The ecological units selected for this study do not differ statistically with regard to the frequency with which emergency rooms are used for these four functions. However, certain individual factors predicting frequency of utilization do differ depending on the unit; for example, patient health status is not uniformly related to the use of emergency rooms for non-urgent reasons in all units. This association is particularly weak in socio-economically deprived units and more significant at higher socio-economic levels.
医院急诊护理在我们的社会中发挥着哪些功能？这些功能如何与急诊室使用者的特征、他们所处的环境以及其他可用的医疗资源相关联？为了回答这些问题，已构建了一个生态概念框架，以及一个能清晰区分个体差异来源（使用者特征）和生态差异（使用者的环境及可用医疗资源）的程序。已确定了四种不同的功能：（1）护理仅在医院才能获得治疗的危急或紧急病例；（2）护理在医院以外其他地方也能获得治疗的紧急病例；（3）护理仅在医院才能获得治疗的非紧急病例；（4）护理在医院以外其他地方也能获得治疗的非紧急病例。本研究选取的生态单元在将急诊室用于这四种功能的频率方面并无统计学差异。然而，某些预测使用频率的个体因素会因单元不同而有所差异；例如，在所有单元中，患者健康状况与因非紧急原因使用急诊室的情况并非始终相关。在社会经济贫困的单元中，这种关联尤其微弱，而在社会经济水平较高时则更为显著。
