Emergency department outcomes for patients experiencing homelessness in England: retrospective cross-sectional study.
Emergency department outcomes for patients experiencing homelessness in England: retrospective cross-sectional study.
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DOI：
10.1093/eurpub/ckac191
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发表时间：
2023-04-01
影响因子：
4.4
通讯作者：
Sutton, Matt
中科院分区：
文献类型：
--
作者：
Moss, Charlie;Anselmi, Laura;Sutton, Matt
对于无家可归的人来说，急诊科是获得医疗保健的重要途径。有证据显示，无家可归的人到急诊室就诊，更可能导致在没有接受治疗的情况下离开急诊室，或在急诊室死亡。我们调查哪些诊断和医疗保健使用模式与这些(和其他)出院目的地以及无家可归患者在7天内再次就诊有关。我们使用国家医院的数据来分析2013-18年间所有109-254名无家可归者在英格兰任何一种类型的急诊中的就诊情况。我们使用Logistic回归来估计每种结果与主要诊断和医疗保健使用模式的关联。与过去没有使用ED的患者相比，过去使用ED频率较高的患者更有可能在7天内不接受治疗就离开并再次就诊。没有在全科注册的患者更有可能不接受治疗就离开或在急诊室死亡，而且计划外再次就诊的几率较低。“社会问题”的初步诊断与出院而无后续行动有关。有精神病学初步诊断的患者被转介到其他卫生保健专业人员/提供者或门诊诊所的可能性不成比例。需要进一步的研究来了解为什么一些无家可归的病人没有得到治疗就离开了急症室，以及他们的医疗需求是否得到了满足。有些病人可能因为缺乏其他服务，例如基层护理和社会福利而经常到急症室求诊。
Emergency departments (EDs) are an important point of access to health care for people experiencing homelessness. Evidence suggests that ED attendances by homeless people are more likely to result in leaving the ED without treatment, or dying in the ED. We investigate which diagnoses and patterns of health care use are associated with these (and other) discharge destinations and re-attendance within 7 days among homeless patients. We used national hospital data to analyze attendances of all 109 254 people experiencing homelessness who presented at any Type 1 ED in England over 2013–18. We used logistic regression to estimate the association of each outcome with primary diagnosis and patterns of healthcare use. Compared with patients with no past ED use, patients with a high frequency of past ED use were more likely to leave without treatment and re-attend within 7 days. Patients not registered at a general practice were likelier to leave without treatment or die in the ED and had lower odds of unplanned re-attendance. A primary diagnosis of ‘social problems’ was associated with being discharged without follow-up. Patients with a psychiatric primary diagnosis were disproportionately likely to be referred to another health care professional/provider or an outpatient clinic. Further research is needed to understand why some homeless patients leave the ED without treatment and whether their healthcare needs are being met. Some patients may be attending the ED frequently due to poor access to other services, such as primary care and social welfare.
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影响因子：
2.9
作者：
Moss C;Sutton M;Cheraghi-Sohi S;Sanders C;Allen T
通讯作者：
Allen T
影响因子：
2.9
作者：
Lewer, Dan;Aldridge, Robert W.;Story, Alistair
通讯作者：
Story, Alistair
影响因子：
3.8
作者：
Rae, Bernadette Emma;Rees, Sharon
通讯作者：
Rees, Sharon
影响因子：
2.3
作者：
Lee, Stuart J.;Thomas, Phillipa;Stafrace, Simon
通讯作者：
Stafrace, Simon
影响因子：
4.4
作者：
Elwell-Sutton, Tim;Fok, Jonathan;Holland, Richard
通讯作者：
Holland, Richard