The association between illness representation profiles and use of unscheduled urgent and emergency health care services
The association between illness representation profiles and use of unscheduled urgent and emergency health care services
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DOI：
10.1111/j.2044-8287.2011.02023.x
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发表时间：
2011-11-01
影响因子：
7.9
通讯作者：
Evans, Bridie Angela
中科院分区：
文献类型：
--
作者：
Lowe, Rob;Porter, Alison;Evans, Bridie Angela
目标。通过为患者提供“第一时间正确的服务”来帮助提供计划外的医疗保健（例如急诊室、家庭医生咨询、药剂师）。然而，服务选择通常是由患者和护理人员而不是服务提供者做出的。自我调节模型（SRM）假设人们以与他们对疾病的理解一致的方式应对。 SRM 用于根据人们的疾病表现检查人们使用初级、二级和社区卫生保健服务的差异，同时还检查与慢性病的关联。历史上的研究都是在独立成分的层面上处理疾病表征；这项研究的重点是组件作为集合（配置文件）的设计和方法。一项普通人口邮政调查从 588 名受访者那里获得了有关服务使用和疾病表征的可用数据。结果。聚类分析发现了三种疾病代表性概况（参与者组），其中包括认为自己的疾病严重、明确、令人痛苦和难以管理的人（组 1）；长期存在且令人担忧，但相信自己能够理解并能够应对（第 2 组）；短期的，影响或关注有限，但性质不明确（第 3 组）。总体而言，第一组比其他组更多地使用二级护理。当考虑疾病的慢性性时，第 1 组更多地使用初级护理来治疗非慢性疾病，而使用二级护理来治疗慢性疾病。结论。调查结果强调了与疾病代表性概况相关的计划外服务的使用差异。调节服务使用的干预措施（例如患者信息活动）可能需要针对特定的服务用户群体进行调整，以优化影响。
Objectives. Provision of unscheduled health care (e.g., emergency department, family doctor consultations, pharmacist) is aided by matching patients with the 'right service, first time'. However, service choice is usually made by patients and carers rather than service providers. The self-regulation model (SRM) posits that people cope in ways consistent with their illness understanding. The SRM was used to examine differences in people's use of primary, secondary, and community health care services according to their illness representation, whilst also examining associations with chronic illness. Research historically treats illness representations at the level of independent components; this research focused on components as sets (profiles).Design and methods. A general population postal survey obtained usable data from 588 respondents on service usage and illness representation.Results. Cluster analysis detected three illness representation profiles (participant groups) comprising people who regarded their illness as serious, unambiguous, distressing, and difficult to manage (group 1); chronic and concerning, but believing they understood and could manage it (group 2); short-term, of limited impact or concern but ambiguous in nature (group 3). Overall, group 1 used secondary care more than the other groups. When considering illness chronicity, group 1 showed more use of primary care with non-chronic conditions and secondary care with chronic conditions.Conclusions. Findings highlighted differences in use of unscheduled services that were related to illness representation profiles. Interventions for moderating service use such as patient information campaigns may need to be tuned towards specific groups of service users to optimize impact.