初级护理的可用性和英语急诊室的可避免出勤:回归分析
Timothy Jamieson1, Hugh Gravelle2, Rita Santos2
1Wolfson Institute of Population Health Queen Mary University of London, London E1 4NS, United Kingdom.
Health policy (Amsterdam, Netherlands)
|May 4, 2025
概括
许多急诊室 (ED) 访问可以避免. 改善初级保健准入,如同日全科医生 (GP) 预约和延长工作时间的意识,可以减少不必要的ED出勤.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生 公共卫生
- 一般实践 一般实践
背景情况:
- 紧急诊所 (ED) 过度拥挤是一个重大问题,因可以在初级保健机构接受护理的患者而加剧.
- 这导致等待时间增加,成本增加,并可能损害护理质量.
研究的目的:
- 调查与可避免的急救人员出勤相关的因素.
- 确定患者的特征,一般诊所的质量,人员配置和延长工作时间是否会影响非紧急或临床上不合适的急救诊所的可能性.
主要方法:
- 分析了144个主要的英语EDs中的1016万名ED出勤者,涉及来自6668家通用诊所的16岁及以上的患者.
- 利用线性概率和后勤回归模型来评估可避免的ED出勤的概率,使用两个定义:NHS (非紧急) 和一个更广泛的 (临床上不合适) 定义.
主要成果:
- 根据NHS的定义,9.3%的ED出勤被认为是可以避免的,随着更广泛的定义,这一比例上升到21.8%.
- 在老年患者,女性患者,贫困地区或人口稀少地区的患者,以及居住在医生诊所附近的患者中,可避免的出院不太常见.
- 促进同日全科医生预约或促进早晨延长工作时间的认识的做法显示,可避免的急救服务人数较少.
结论:
- 患者的人口统计和地理因素影响可避免的ED使用.
- 提高初级保健的可访问性,包括同一天的预约和延长时间的有效沟通,可以减轻不必要的ED访问.
- 虽然周末/晚上延长工作时间显示,临床上不合适的急救诊所的数量略有减少,但整体提供并没有显著相关.
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