Deciding to Attend the Emergency Department: Experiences of Patients With Inflammatory Arthritis.

IF 3.6 2区医学 Q2 RHEUMATOLOGY Journal of Rheumatology Pub Date : 2024-10-01 DOI:10.3899/jrheum.2024-0111

Emilie Pianarosa, Pam Roach, Claire E H Barber, Brian R Holroyd, Patrick McLane, Steven J Katz, Meghan J Elliott, Nazret Russon, Clare Hildebrandt, Kelsey Chomistek, Eileen Davidson, Stephanie Keeling, Cheryl Barnabe

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Abstract

Objective: Patients may use emergency departments (EDs) to meet their health needs when ambulatory care systems are not sufficient. We aim to describe contributing factors to the decision made by persons with inflammatory arthritis (IA) to present to the ED, as well as their experiences of ED care and postdischarge follow-up.

Methods: An embedded mixed-methods approach was taken to contextualize quantitative data with associated free-text responses from an online survey distributed to residents of Alberta with a known IA condition and an ED visit.

Results: Eighty-two persons (63% aged 16-55 years, 48% female, 50% urban residents) with rheumatoid arthritis (48%), psoriatic arthritis (12%), spondyloarthritis (6%), or gout (34%) completed the survey. Presenting concerns were arthritis flare (37%), chest pain (15%), injury (12%), and infection (11%). Of all visits, 29% proceeded directly to the ED, 35% attempted accessing ambulatory care first, and 32% arrived for a return visit. In presentations for arthritis flare, patients were aware of the rheumatology service being contacted by the ED provider for advice in just 9% of events. Challenges in healthcare system coordination and system pressures resulted in patients requiring ED attendance to assess their concern. The quality of communication and relationality developed between patients with IA and healthcare providers informed experiences of ED care.

Conclusion: Modifying rheumatology ambulatory care models could better meet patient needs and ultimately reduce avoidable ED use by patients with IA.

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炎症性关节炎患者就诊决策和使用急诊科的经历。

目的：当非卧床医疗系统不足以满足患者的健康需求时，他们可能会使用急诊科（ED）来满足自己的健康需求。我们旨在描述导致炎症性关节炎（IA）患者决定到急诊科就诊的因素，以及他们在急诊科就诊和出院后随访的经历：方法：采用嵌入式混合方法，将定量数据与相关的自由文本回复结合起来，这些自由文本回复来自一项在线调查，调查对象是艾伯塔省已知患有炎症性关节炎并曾到急诊室就诊的居民：82名患有RA（48%）、PsA（12%）、SpA（6%）和痛风（34%）的患者（63%为16-55岁，48%为女性，50%为城市居民）完成了调查。主要表现为关节炎复发（37%）、胸痛（15%）、受伤（12%）和感染（11%）。在所有就诊者中，29%的人直接到急诊室就诊，35%的人试图先接受非住院治疗，32%的人是回访。在因关节炎复发而就诊的患者中，仅有 9% 的患者知道急诊室提供者会联系风湿病服务机构寻求建议。只有 26% 的患者被要求与风湿免疫科医生进行随访，其中 38% 的患者无法在建议的时间内进行随访。医疗系统协调方面的挑战和系统压力导致患者需要到急诊室就诊，以评估其担忧的问题。风湿免疫科患者与医疗服务提供者之间的沟通质量和关系的发展，为急诊室护理的体验提供了参考：修改风湿病门诊护理模式可以更好地满足患者的需求，最终减少内科病人使用可避免的急诊室。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Rheumatology 医学-风湿病学

CiteScore

6.50

自引率

5.10%

发文量

285

审稿时长

1 months

期刊介绍： The Journal of Rheumatology is a monthly international serial edited by Earl D. Silverman. The Journal features research articles on clinical subjects from scientists working in rheumatology and related fields, as well as proceedings of meetings as supplements to regular issues. Highlights of our 41 years serving Rheumatology include: groundbreaking and provocative editorials such as "Inverting the Pyramid," renowned Pediatric Rheumatology, proceedings of OMERACT and the Canadian Rheumatology Association, Cochrane Musculoskeletal Reviews, and supplements on emerging therapies.