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At least 19 recordsLinked to original sources
PubMed1997

[Socioeconomic determinants and utilization of emergency hospital services].

BACKGROUND: Socioeconomic level is a key determinant for health status. It may also influence on the utilization of hospital emergency services, although the factor responsible for that is not known. The main objective of the present report is to assess whether patients using frequently hospital emergency services have one or more variables related to low socioeconomic level. PATIENTS AND METHODS: A standardized questionnaire was applied to 800 patients randomly selected from those attending the emergency services of a provincial reference hospital. It was gathered information on: income, education level, employment, loneliness, domestic violence, occupational accidents, and life style. Odds ratios (OR) and their 95% confidence intervals (CI) were estimated. Stepwise logistic regression analysis was used to ascertain the independent predictors for attending for than once to the emergency services. RESULTS: In crude analysis, low income and low educational level were significantly related to the use of emergency services (both chi 2 for a trend < 0.05). Alcoholism (OR = 2.3, 95% CI = 1.2-4.7) and domestic violence (OR = 2.6, 95% CI = 0.9-8.1) were also related. Stepwise logistic regression analysis selected income (OR for intermediate level = 1.6, 95% CI = 1.0-2.7, and OR for low level = 2.3, 95% CI = 1.4-3.7) and alcoholism (OR = 2.9, 95% CI = 1.3-6.4) as independent predictors. CONCLUSIONS: Patients with low income and/or alcoholism use emergency hospital services more frequently.

Adult↗
PubMed1990

Socio-spatial perspectives on the utilization of emergency hospital services in two urban territories in Quebec.

Hospital emergency services located in urban areas have been severely congested for several years in the province of Quebec. This problem is not caused by ambulatory patients who are using emergency services as a regular source of care, but by patients in need of emergency services. To study the factors affecting the utilization rates of emergency services in two urban areas, the city of Laval and the Quebec metropolitan area, two samples of more than 30,000 patients each were drawn from the 1981 file of the Régie de l'assurance-maladie du Quebec. The utilization rates of emergency services for emergent and urgent causes in these two samples were computed on the basis of the census tract location of these patients. The socio-economic characteristics of these census tracts were taken from the 1981 Canadian census, the distance travelled from each census tract to the location of hospital emergency services was computed and included as a predictor of the utilization rates. Also, the prevalence of chronic and psychiatric diagnoses were obtained for each census tract. The result of the analysis showed that distance affected the utilization rates only in the Quebec metropolitan area where the hospitals are mostly located in the downtown area near deprived and working class neighbourhoods, while the socio-economic characteristics affected the utilization rates in both Quebec and Laval.

Age Factors↗
PubMed1993

A descriptive study of care processes using total quality management as a framework in a USAF regional hospital emergency service and related services.

The purpose of this descriptive study was to investigate access to care processes in a military regional hospital Emergency Service (ES) and related services using a Total Quality Management framework. Tabulations of demographic survey data revealed that the ES is used mainly as a primary care clinic, with a greater proportion of pediatric care provided during peak hours. An analysis of patterns of care processes in the organizational system revealed that there was little in common between Total Quality Management and Continuous Quality Improvement principles and the care processes. The results of the analysis lend support to the proposed USAF decentralized, coordinated health care system with more authority and control given to local commands and emphasis upon increased responsibility and accountability within professional and beneficiary communities.

Adolescent↗
PubMed1997

[Outpatient emergency care in pneumology. A method to alleviate pressure of hospital emergency services].

We analyze the result of using a pneumological rapid-attention facility for diagnosis and immediate treatment of patients with respiratory symptoms arriving at the emergency room of University Hospital Virgen del Rocío in Seville (Spain). In the first six months the outpatient service saw 321 patients (male/female ratio 2.6), most of whom were between 55 and 75 years of age and had never before seen a pneumologist (83.4%). Dyspnea was the most common respiratory symptom named (by 35% of patients), and acute exacerbation of chronic obstructive pulmonary disease was the most usual diagnosis (in 19.1%). Only 21 (7%) were admitted to the hospital. We that creating the outpatient unit effectively met a societal need for rapid diagnosis and treatment of patients with respiratory complaints in the area served by our hospital emergency service.

Adolescent↗
PubMed1996

[The frequency of the use of hospital emergency services: the motivations and characteristics of pediatric emergencies].

It is well known the high attendance frequency of the hospital emergency services (HES). In order to know the reason and justification of this demand, the emergency visits to the reference HES from a paediatrician population of our Health Center are studied. The results of a questionnaire of 304 emergencies are analyzed and compared with the level of frequency of the children to the HES. The follow-up of the emergency in the health center is also assessed. 82% of the emergencies attend the HES by themselves and the main reason to justify this behaviour were (up to two arguments): the paediatrician schedule unfit their requirements (55.5%), the likelihood to perform complementary tests (42.3%), rather than the severity of the process of the child (28.3%). The lower is the mean of brothers and sisters and the social class of the father, the higher is the frequency to the HES. 4.5% of the emergencies ended inpatient, and in 33% a complementary tests was performed. The lesser complementary tests are conducted the higher is the frequency to the HES (p = 0.001). Bases on the medical assessment, the emergency is justified in 28.1% of the cases, but it raised up to 44.4% when social arguments are also considered by the doctor who attended the emergency. 50% observe the advised to follow up in the Health Center, accomplishing better those with higher frequency. We consider that social and psychological elements of the children family, and the need to resolve the health problem as soon as possible, are two considerations more important than the severity of the process in the genesis of over-utilization of the HES.

Analysis of Variance↗
PubMed1987

Categorization of hospital emergency services--developing valid criteria.

In a pilot project sponsored by the California State Emergency Medical Services Authority, validated, verifiable criteria were developed for the vertical categorization of hospital emergency services in 11 different groupings of medical and surgical emergencies. We describe the development of an assessment process and categorization criteria to identify the most appropriate receiving facility for interfacility transfer and, in selected instances, field triage of patients with different levels of severity of illness or injury. We propose that this facility assessment project be used in the critical care planning process for the eventual vertical categorization of hospital emergency services in California and as a template for similar projects in other states.

California↗
PubMedDate not supplied

[The utilization of a hospital emergency service].

BACKGROUND: The use of the emergency room of a hospital during a year has been studied, in the last few years, the use of hospital emergency rooms has increased alarmingly, and a large number of patients come by their own initiative. With regard to this problem, we have considered it adequate to carry out this survey, in order to know the situation of hospital emergency rooms in our community. METHODS: We carry out a retrospective study from an aleatory representative sample of patients, cared during a year (from June, 1987 to June 1988) in the hospital emergency room of a health area in Asturias. RESULTS: Frequentation was 116 per a thousand inhabitants a year and old-aged population constituted the largest number of people using this unit. The largest inflow of patients took place at 12 to 14 hours. Men came with a significant higher frequency than women. More than a half of patients came upon their own initiative. The percentage of justified admissions and emergencies was significatively higher among the patients sent by a doctor than among those ones who came by their own initiative, an it was higher when the doctor belonged to a Health Care Center, compared with doctors belonging to the traditional model. CONCLUSIONS: There exists a high index of non-justified emergencies and the hospital is used as a Primary Health Care center.

Adolescent↗
PubMed1997

[Detection of cognitive deterioration in elderly patients attending an emergency hospital service].

BACKGROUND: An increasing proportion of patients attended at hospital emergence departments (HED) are elderly people. OBJECTIVES: a) To check the reliability of the usual medical assessment to detect the cognitive deterioration in elderly people attended at HED, compared with that performed systematically by means of an evaluation test of cognitive functions; b) to study the applicability of such a test in HED, on the basis of the time necessary for its administration, and c) to describe the deterioration prevalence in that group of patients and identify the possible associated risks for its detection in patients. PATIENTS AND METHODS: Prospective study including patients aged > or = 60 years attended at a HED, using the orientation, memory and concentration test (OMC) to perform the cognitive assessment. RESULTS: A total of 352 patients who had no exclusion criteria out of the 536 attended during the study period were included. Cognitive deterioration was not detected in 111 patients (31.5%); it was mild in 147 (41.8%), moderate in 71 (20.2%) and severe in 23 (6.5%). In patients with moderate-severe deterioration according to the OMC test, such a deterioration was detected by the usual medical evaluation in 7% of cases. The mean time in completing the test was 2.6 +/- 0.9 minutes. An age > or = 80 years was associated with an increased relative risk for detecting moderate-severe cognitive deterioration (1.98; 95% CI, 1.42-2.78; p < 0.001), whereas the discharge diagnosis of respiratory disease was associated with a decrease of the relative risk (0.41; 95% CI, 0.19-0.89; p < 0.05). No association was observed with other factors, such as gender, home residence or final destination from the emergency department. CONCLUSIONS: The prevalence of cognitive deterioration in elderly people attended at HED is high and increases with age. The OMC test can be administered at HED to detect cognitive deterioration, which is not frequently detected by the usual medical assessment.

Age Factors↗
PubMed1996

[Impact of the primary health care reform on the use of the hospital emergency services].

BACKGROUND: The overutilization of the hospital emergency areas (HEA) in recent years has been related to an inadequate functioning of the primary health care and can be corrected by the implementation of the primary health care reform. MATERIAL AND METHODS: Home interview of a sample of residents of the city of Mataró (Barcelona, Spain), where the primary health care reform affects to four of the seven basic health areas. Collection of information on health care utilization and attitudes to its use. RESULTS: Of the 1,974 studied subjects 27% (CI 95%, 25-29) reported to have used the HEA in the former year, and the frequency of visits was 0.48 (CI 95%, 0.44-0.54) per person. For the 1880 beneficiaries of the national health system, these results were somewhat lower between the users of reformed centres (27%, 0.46) than those of non-reformed centres (30%, 0.50) (p = NS); differences were attributed mainly to adult women. Users of reformed centres expressed more preference for the ambulatory in case of a non-severe emergency (37% and 17%; p < 0.0001) and consulted more often before going to the HEA (17 and 10%; p = 0.03). Among the reasons to go to the HEA, users of the reformed model perceived less necessity of an immediate action (43 and 52%; p = 0.05) and greater time barriers with the basic health areas (23 and 15%; p = 0.04). CONCLUSIONS: In spite of the lack of overall differences in the use of HEA between users of reformed centres and non-reformed centres we observed a lower utilization in some age and sex groups from reformed centres. Some elements of the demand of the HEA are more appropriate and attributed to the primary health care reform. However, the reasons prompting to use the HEA show that an unjustified utilization is still done, independently of the primary health care model.

Adult↗