社会经济条件差的老年人急诊科频繁使用的驱动因素:一项定性研究。

IF 4.5 2区 医学 Q1 GERIATRICS & GERONTOLOGY
Anita Chary, Annika Bhananker, Michelle Suh, David Leavitt, Elise Brickhouse, Shreya Tamma, Jose Ramirez, Mariana Rios, Aanand D. Naik, Margaret Samuels-Kalow, Naomi George
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引用次数: 0

摘要

背景:急诊科(ED)是社会经济上处于不利地位的老年人的安全网和医疗保健访问的共同点。社会经济上处于不利地位的老年ED患者对其健康、医疗保健获取和ED使用的看法知之甚少。这些见解可以指导有针对性的干预措施,以解决未得到满足的临床和与健康有关的社会需求。方法:我们对一家公共安全网医院急诊科的老年人进行了定性研究。我们采访了在过去一年中有≥4次急诊科就诊的60岁以上患者。半结构化访谈探讨了认知健康需求和急诊科就诊的动机。我们使用有效的方法筛选HRSN。基于Andersen的健康服务使用行为模型,我们进行了内容分析来评估ED使用的关键驱动因素,并使用叙事分析的原则来确定频繁使用ED的老年患者的不同特征。结果:在68名受访者中,40%为黑人,43%为西班牙裔。60%的人有医疗保险。大多数参与者(63%)报告了HRSN,但很少将其描述为ED使用的主要驱动因素。相反,难以获得门诊护理和与特定疾病需求相关的医疗复杂性是最突出的因素。出现了6种不同的患者特征:(1)缺乏保险和初级保健;(二)病情危急的;(3)对严重的潜在疾病有严重的担忧;(4)患有慢性疾病,其治疗介于门诊和住院之间;(5)有前哨事件(如跌倒、手术)并伴有级联后遗症;(6)反复面临留置导管、导管和长期血管通路管理的挑战。结论:在我们的样本中处于社会经济劣势的老年人中,医疗复杂性是频繁使用急诊科的一个更显著的驱动因素,而不是未满足的社会需求。这一人群需要创新,以加强门诊护理,并提供替代急诊科和住院治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Drivers of Frequent Emergency Department Use in Socioeconomically Disadvantaged Older Adults: A Qualitative Study

Drivers of Frequent Emergency Department Use in Socioeconomically Disadvantaged Older Adults: A Qualitative Study

Background

The emergency department (ED) is the safety net for and a common point of healthcare access for socioeconomically disadvantaged older adults. Little is known about socioeconomically disadvantaged older ED patients' perspectives on their health, healthcare access, and ED use. Such insights could guide tailored interventions to address unmet clinical and health-related social needs (HRSN).

Methods

We performed a qualitative study with older adults in a single public safety net hospital ED. We interviewed patients age 60+ who had ≥ 4 ED 4 visits in the past year. Semi-structured interviews explored perceived health needs and motivations underlying ED visits. We screened for HRSN using validated measures. We performed content analysis to evaluate key drivers of ED use based on Andersen's Behavioral Model of Health Services Use and used principles of narrative analysis to identify distinct profiles of older patients with frequent ED use.

Results

Among 68 interview participants, 40% identified as Black and 43% as Hispanic. Sixty percent had health insurance. Most participants (63%) reported HRSN, but rarely described these as primary drivers of ED use. Instead, poor access to outpatient care and medical complexity related to condition-specific needs were the most salient factors. Six distinct profiles emerged of patients who: (1) lacked insurance and primary care; (2) faced an acute condition; (3) held acute concerns related to serious underlying diseases; (4) had chronic disease whose management bordered between outpatient and inpatient settings; (5) had a sentinel event (e.g., fall, surgery) with cascading sequelae; (6) faced recurrent challenges managing indwelling catheters, tubes, and long-term vascular access.

Conclusions

Among socioeconomically disadvantaged older adults in our sample, medical complexity was a more salient driver of frequent ED use than unmet social needs. Innovations to strengthen outpatient care and offer alternatives to ED and hospital admission are needed for this population.

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来源期刊
CiteScore
10.00
自引率
6.30%
发文量
504
审稿时长
3-6 weeks
期刊介绍: Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.
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