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首页> 外文期刊>Canadian Journal of Emergency Medicine >Factors associated with choosing the emergency department as the primary access point to health care: a Canadian population cross-sectional study
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Factors associated with choosing the emergency department as the primary access point to health care: a Canadian population cross-sectional study

机译：选择急诊室作为医疗保健的主要途径的相关因素：加拿大人口横断面研究

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Objective Approximately 4.3 million Canadians are without a primary care physician, of which 13% choose the emergency department (ED) as their regular access point to health care. We sought to identify factors associated with preferential ED use over other health services. We hypothesized that socioeconomic barriers (i.e., employment, health status, education) to primary care would also prevent access to ED alternatives. Methods Data from the Canadian Community Health Survey, 2007 to 2008, were analysed (N=134,073; response rate 93.5%). Our study population comprised 14,091 individuals identified without a primary care physician. Socioeconomic variables included employment, health, and education. Covariates included chronic health conditions, immigrant status, gender, age, and mental health. Prevalence estimates and 95% confidence intervals (CIs) for each variable were calculated. Weighted logistic regression models were constructed to evaluate the importance of individual risk factors and their interactions after adjustment for relevant covariates. Results The sample comprised 57.2% males from across Canada. Employment (OR 0.73 [95% CI: 0.59-0.90]), good health (OR 0.73 [95% CI 0.57-0.88]), and post-secondary education (OR 0.68 [95% CI 0.53-0.88]) reduced respondents use of the ED. The reduced odds of ED use were independent of chronic conditions, mental health, gender, poor mobility, province, and age. Conclusions Low socioeconomic status dictates preferential ED use in those without a primary care physician. Specific policy and system development targeting this at-risk population are indicated to alter ED use patterns in this population.
机译：目标约有430万加拿大人没有基层医疗医生，其中13％的人选择急诊科（ED）作为他们定期获得医疗保健的途径。我们试图确定与优先使用ED相比其他医疗服务相关的因素。我们假设，初级保健的社会经济障碍（即就业，健康状况，教育）也将阻止获得急诊科替代治疗的机会。方法分析加拿大社区健康调查（Canadian Community Health Survey）2007年至2008年的数据（N = 134,073;答复率93.5％）。我们的研究人群包括14,091名没有初级保健医生的人。社会经济变量包括就业，健康和教育。协变量包括慢性健康状况，移民身份，性别，年龄和心理健康。计算每个变量的患病率估计值和95％置信区间（CI）。构建加权逻辑回归模型以评估各个风险因素及其相关协变量调整后的相互作用的重要性。结果样本包括来自加拿大各地的57.2％的男性。就业（OR 0.73 [95％CI 0.57-0.88]），良好的健康状况（OR 0.73 [95％CI 0.57-0.88]）和中等教育（OR 0.68 [95％CI 0.53-0.88]）减少了受访者的使用ED。减少使用ED的几率与慢性病，心理健康，性别，行动不便，省份和年龄无关。结论低社会经济地位决定了在没有初级保健医师的情况下优先使用ED。针对该高危人群的特定政策和系统开发表明可以改变该人群的ED使用模式。

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