Continuity of primary care and emergency department utilization among elderly people
Continuity of primary care and emergency department utilization among elderly people
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DOI：
10.1503/cmaj.061615
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发表时间：
2007-11-20
影响因子：
14.6
通讯作者：
Pineault, Raynald
中科院分区：
文献类型：
--
作者：
Ionescu-Ittu, Raluca;McCusker, Jane;Pineault, Raynald
背景：65岁或以上的人代表了越来越多的急诊科用户。我们调查了初级保健的特点（可及性和连续性）是否与老年人在城市和农村area.Methods急诊科使用：我们进行了一项横断面研究，随机抽样的95 173人年龄在65岁或以上的信息，从省级行政数据库在魁北克为2000年和2001年。我们获得了患者的年龄、性别、合并症、急诊使用率（每1000天有风险的急诊就诊天数[即，在2年研究期间存活且未住院]）、使用医院和门诊医生服务、居住地（城市与农村）、社会经济地位、获得（医生：人口比率，初级医生的存在）和初级保健的连续性。在调整了年龄、性别和合并症后，我们发现急诊使用率的增加与缺乏主治医生有关（校正率比[RR] 1.45，95%置信区间[CI] 1.41-1.49）和低或中（v.高）水平的初级医生护理连续性（调整后的RR分别为1.46，95% CI 1.44-1.48和1.27，95% CI 1.25-1.29）。急诊服务使用率增加的其他重要预测因素是居住在农村地区、社会经济地位低和居住在医生与人口比例较高的地区。在有初级医生的患者中，护理的连续性在城市比在农村地区有更强的保护作用。解释：有一个初级医生和更大的连续性与该医生的护理是与老年人，特别是那些生活在城市地区的急诊科使用减少的因素。
Background: People aged 65 years or more represent a growing group of emergency department users. We investigated whether characteristics of primary care ( accessibility and continuity) are associated with emergency department use by elderly people in both urban and rural areas.Methods: We conducted a cross-sectional study using information for a random sample of 95 173 people aged 65 years or more drawn from provincial administrative databases in Quebec for 2000 and 2001. We obtained data on the patients' age, sex, comorbidity, rate of emergency department use ( number of days on which a visit was made to an amergency department per 1000 days at risk [i.e., alive and not in hospital] during the 2-year study period), use of hospital and ambulatory physician services, residence ( urban v. rural), socioeconomic status, access ( physician: population ratio, presence of primary physician) and continuity of primary care.Results: After adjusting for age, sex and comorbidity, we found that an increased rate of emergency department use was associated with lack of a primary physician ( adjusted rate ratio [RR] 1.45, 95% confidence interval [CI] 1.41-1.49) and low or medium ( v. high) levels of continuity of care with a primary physician ( adjusted RR 1.46, 95% CI 1.44-1.48, and 1.27, 95% Cl 1.25-1.29, respectively). Other significant predictors of increased use of emergency department services were residence in a rural area, low socioeconomic status and residence in a region with a higher physician: population ratio. Among the patients who had a primary physician, continuity of care had a stronger protective effect in urban than in rural areas.Interpretation: Having a primary physician and greater continuity of care with this physician are factors associated with decreased emergency department use by elderly people, particularly those living in urban areas.