REGULAR SOURCE OF AMBULATORY CARE AND MEDICAL-CARE UTILIZATION BY PATIENTS PRESENTING TO A PUBLIC HOSPITAL EMERGENCY DEPARTMENT
REGULAR SOURCE OF AMBULATORY CARE AND MEDICAL-CARE UTILIZATION BY PATIENTS PRESENTING TO A PUBLIC HOSPITAL EMERGENCY DEPARTMENT
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DOI：
10.1001/jama.271.24.1909
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发表时间：
1994-06-22
影响因子：
120.7
通讯作者：
BROOK, RH
中科院分区：
文献类型：
--
作者：
BAKER, DW;STEVENS, CD;BROOK, RH
目的.-确定门诊急诊科患者的常规护理来源以及常用医疗服务提供者与医疗服务使用之间的关系。设计.-横断面调查。设置.-加利福尼亚州洛杉矶县的一家公立医院。患者.-在 2 周内共有 1190 名稳定的门诊成年人到急诊科就诊。主要结果指标.-自我报告的常规护理来源、平时的健康状况和最近就诊的医生就诊结果 - 共有 16% 的患者将急诊科作为他们的常规护理来源。该群体中有四分之一的人报告健康状况一般或较差。非裔美国人和拉丁裔比白人更有可能将急诊科作为他们的常规护理来源。与通常在办公室或诊所就诊的患者相比，将急诊科作为常规护理来源的患者就诊次数减少了 25%，并且在过去 3 个月内就诊的可能性也较小（相对风险，0.45；95% 置信区间，0.28 至 0.70）。在所有患者中，56% 已确诊；急诊科以外的常规护理来源，但最近就诊的所有医生中，有 24% 至 36% 仍然发生在急诊科。结论：我们的患者严重依赖急诊科门诊医生就诊，无论他们报告的常规护理来源如何。然而，将急诊科作为常规门诊护理来源的患者使用医生服务的频率低于在其他环境中获得医疗服务提供者的患者。这些问题需要通过基于人口的调查进行进一步评估。
Objective.-To determine the regular source of care and the relationship between usual provider and use of medical services among ambulatory emergency department patients.Design.-Cross-sectional survey.Setting.-A public hospital in Los Angeles County, California.Patients.-A total of 1190 stable, ambulatory adults presenting to the emergency department during a 2-week period.Main Outcome Measures.-Self-reported regular source of care, usual health status, and recent physician visits.Results.-A total of 16% of the patients identified ah emergency department as their regular source of care. One fourth of this group reported fair or poor health. African Americans and Latinos were more likely than whites to identify an emergency department as their regular source of care. Patients who identified an emergency department as their regular source of care had 25% fewer physician visits and were less likely to have seen a physician during the preceding 3 months than patients who were usually seen in an office or clinic (relative risk, 0.45;95% confidence interval, 0.28 to 0.70). Of all patients, 56% identified; a regular source of care other than an emergency department, but 24% to 36% of all their recent physician visits still occurred in an emergency department.Conclusion.-Our patients rely heavily on emergency departments for ambulatory physician visits, regardless of their reported regular source of care. However, patients who identify an emergency department as their regular source of ambulatory care used physician services less frequently than patients with access to providers in other settings. These issues require further evaluation with population-based surveys.