What are the social predictors of accident and emergency attendance in disadvantaged neighbourhoods? Results from a cross-sectional household health survey in the north west of England
What are the social predictors of accident and emergency attendance in disadvantaged neighbourhoods? Results from a cross-sectional household health survey in the north west of England
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DOI：
10.1136/bmjopen-2018-022820
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发表时间：
2019-06-01
期刊：
影响因子：
2.9
通讯作者：
Barr, Ben
中科院分区：
文献类型：
--
作者：
Giebel, Clarissa;McIntyre, Jason Cameron;Barr, Ben
目的本研究的目的是确定最重要的决定因素事故和紧急情况（A&E）出席在弱势地区。来自英格兰西北海岸地区20个弱势社区的3510名居民完成了一项全面的公共卫生调查。主要结果测量要求参与者填写一般背景信息，以及有关其身体健康、心理健康、生活方式、社会问题、住房和环境、工作和财务以及医疗保健服务使用情况的信息。每户只能有一名居民参加调查。采用泊松回归分析评估前12个月急诊室就诊频率的预测因子。结果31.6%的调查对象报告在过去12个月内去过急症室，就诊次数从1次到95次不等。控制人口和健康因素，没有就业和生活在质量差的住房增加了参加急诊服务的可能性。服务可及性也被发现可以预测急诊室的出勤率，因为离全科医生（GP）每近一公里，每100人的急诊室出勤率就会减少18人，离急诊室每远一公里，每100人的急诊室出勤率就会减少3人。这是第一次调查，探讨了一套全面的社会经济因素，以及接近全科医生和急诊科服务作为预测在弱势地区急诊科出勤率。这项研究的结果表明，需要解决社会经济问题，如就业和住房质量，以及结构性问题，如公共交通和获得初级保健，以减轻目前急诊科的负担。
Objectives The aim of this study was to identify the most important determinants of accident and emergency (A&E) attendance in disadvantaged areas.Design, setting and participants A total of 3510 residents from 20 disadvantaged neighbourhoods in the North West Coast area in England completed a comprehensive public health survey.Main outcome measures Participants were asked to complete general background information, as well as information about their physical health, mental health, lifestyle, social issues, housing and environment, work and finances, and healthcare service usage. Only one resident per household could take part in the survey. Poisson regression analysis was employed to assess the predictors of A&E attendance frequency in the previous 12 months.Results 31.6% of the sample reported having attended A&E in the previous 12 months, ranging from 1 to 95 visits. Controlling for demographic and health factors, not being in employment and living in poor quality housing increased the likelihood of attending an A&E service. Service access was also found to be predictive of A&E attendance insofar as there were an additional 18 fewer A& E attendances per 100 population for each kilometre closer a person lived to a general practitioner (GP) practice, and 3 fewer attendances per 100 population for each kilometre further a person lived from an A&E department.Conclusions This is one of the first surveys to explore a comprehensive set of socio-economic factors as well as proximity to both GP and A&E services as predictors of A&E attendance in disadvantaged areas. Findings from this study suggest the need to address both socioeconomic issues, such as employment and housing quality, as well as structural issues, such as public transport and access to primary care, to reduce the current burden on A& E departments.