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Nursing Science 2025
基于安德森模型的非急症患者急诊就诊影响因素研究进展
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Abstract:
近年来，非急症患者占用急诊资源的现象日益突出，这不仅加剧急诊科的拥挤情况，还导致医疗资源的不合理利用。本文基于安德森医疗服务利用行为模型，总结非急症患者选择急诊就诊的影响因素。模型从“倾向因素”(人口学特征、健康信念)、“使能因素”(经济能力、医疗资源可及性)及“需求因素”(自评健康状态、症状严重程度)三个维度，揭示患者决策的复杂性。研究发现，低健康素养、缺乏基层医疗渠道、对急诊服务认知偏差及症状主观焦虑是主要驱动因素。本文提出未来需通过普及急诊相关健康知识及分级诊疗政策、加强基层医疗建设，为急诊医疗资源的高效、合理利用提供理论依据。
In recent years, the phenomenon of non-urgent patients utilizing emergency departments (EDs) has become increasingly prominent, exacerbating ED overcrowding and inefficient allocation of medical resources. Based on Anderson’s Behavioral Model of Health Services Utilization, this paper systematically reviews the factors influencing non-urgent patients’ choice of ED care. The model categorizes determinants into three dimensions: predisposing factors (demographics, health beliefs), enabling factors (economic capacity, healthcare accessibility), and need factors (self-assessed health status, symptom severity), revealing the complexity of patient decision-making. Key drivers include low education levels, lack of primary care access, misconceptions about ED services, and subjective anxiety over symptoms. This article proposes that the efficient allocation of emergency resources should be supported by popularizing health knowledge related to emergency care and implementing hierarchical diagnosis and treatment policies, as well as strengthening the construction of primary healthcare.
| [1] | Zaboli, A., Turcato, G., Brigiari, G., Massar, M., Ziller, M., Sibilio, S., et al. (2024) Emergency Departments in Contemporary Healthcare: Are They Still for Emergencies? An Analysis of over 1 Million Attendances. Healthcare, 12, Article 2426. https://doi.org/10.3390/healthcare12232426 |
| [2] | Andrea, M.K., Pries-Heje, M., Hasselbalch, R.B., et al. (2023) Causes of Death among Non-Urgent Patients in the Emergency Department Who Die within 30 Days. Danish Medical Journal, 70, A01230037. |
| [3] | Mantas, J., Hasman, A., Gallos, P., et al. (2016) Reducing Emergency Department Crowding: Evidence Based Strategies. Studies in Health Technology and Informatics, 226, 67-70. |
| [4] | Naouri, D., Ranchon, G., Vuagnat, A., Schmidt, J., El Khoury, C. and Yordanov, Y. (2019) Factors Associated with Inappropriate Use of Emergency Departments: Findings from a Cross-Sectional National Study in France. BMJ Quality & Safety, 29, 449-464. https://doi.org/10.1136/bmjqs-2019-009396 |
| [5] | Alnasser, S., Alharbi, M., AAlibrahim, A., Aal ibrahim, A., Kentab, O., Alassaf, W., et al. (2023) Analysis of Emergency Department Use by Non-Urgent Patients and Their Visit Characteristics at an Academic Center. International Journal of General Medicine, 16, 221-232. https://doi.org/10.2147/ijgm.s391126 |
| [6] | Bahadori, M., Mousavi, S.M., Teymourzadeh, E. and Ravangard, R. (2019) Emergency Department Visits for Non-Urgent Conditions in Iran: A Cross-Sectional Study. BMJ Open, 9, e030927. https://doi.org/10.1136/bmjopen-2019-030927 |
| [7] | Al-Otmy, S.S., Abduljabbar, A.Z., Al-Raddadi, R.M. and Farahat, F. (2020) Factors Associated with Non-Urgent Visits to the Emergency Department in a Tertiary Care Centre, Western Saudi Arabia: Cross-Sectional Study. BMJ Open, 10, e035951. https://doi.org/10.1136/bmjopen-2019-035951 |
| [8] | 李月娥, 卢珊. 安德森模型的理论构建及分析路径演变评析[J]. 中国卫生事业管理, 2017, 34(5): 324-327, 334. |
| [9] | Graham, A., Hasking, P., Brooker, J., Clarke, D. and Meadows, G. (2017) Mental Health Service Use among Those with Depression: An Exploration Using Andersen's Behavioral Model of Health Service Use. Journal of Affective Disorders, 208, 170-176. https://doi.org/10.1016/j.jad.2016.08.074 |
| [10] | Unwin, M., Kinsman, L. and Rigby, S. (2016) Why Are We Waiting? Patients’ Perspectives for Accessing Emergency Department Services with Non-Urgent Complaints. International Emergency Nursing, 29, 3-8. https://doi.org/10.1016/j.ienj.2016.09.003 |
| [11] | O’Keeffe, C., Mason, S., Jacques, R. and Nicholl, J. (2018) Characterising Non-Urgent Users of the Emergency Department (ED): A Retrospective Analysis of Routine ED Data. PLOS ONE, 13, e0192855. https://doi.org/10.1371/journal.pone.0192855 |
| [12] | Krämer, J. and Schreyögg, J. (2019) Substituting Emergency Services: Primary Care vs. Hospital Care. Health Policy, 123, 1053-1060. https://doi.org/10.1016/j.healthpol.2019.08.013 |
| [13] | Jimenez, M.L.C., Manzanera, R., Carascal, M.B., Figueras, M.D., Wong, J.Q., Moya, D., et al. (2021) Factors Affecting the Non‐Urgent Consultations in the Emergency Department of a Tertiary Hospital in the Philippines: A Cross‐Sectional Study. Emergency Medicine Australasia, 33, 349-356. https://doi.org/10.1111/1742-6723.13725 |
| [14] | Jiang, L., Ye, L., Dai, M., Zhou, J. and Li, Q. (2020) Use Andersen’s Behavior Model to Explain Non-Urgent Visits in Emergency Department: A Single Center Study in Southwest China. International Emergency Nursing, 52, Article ID: 100845. https://doi.org/10.1016/j.ienj.2020.100845 |
| [15] | El-Masri, M., Bornais, J., Omar, A. and Crawley, J. (2020) Predictors of Nonurgent Emergency Visits at a Midsize Community-Based Hospital System: Secondary Analysis of Administrative Health Care Data. Journal of Emergency Nursing, 46, 478-487. https://doi.org/10.1016/j.jen.2020.02.002 |
| [16] | Alyasin, A. and Douglas, C. (2014) Reasons for Non-Urgent Presentations to the Emergency Department in Saudi Arabia. International Emergency Nursing, 22, 220-225. https://doi.org/10.1016/j.ienj.2014.03.001 |
| [17] | 王晓雯, 孔祥金, 赵璐, 等. 三甲医院非急症患者基层首诊意愿及态度调查研究[J]. 现代医院管理, 2020, 18(5): 32-36. |
| [18] | Davis, J.W., Fujimoto, R.Y., Chan, H., et al. (2010) Identifying Characteristics of Patients with Low Urgency Emergency Department Visits in a Managed Care Setting. Managed Care, 19, 38-44. |
| [19] | Alhojelan, A.M., Al Rusayni, Y.A., Alsaif, E., Aldoubiab, R.K., Aloqla, A., Aloraini, A.A., et al. (2024) Analyzing Non-Urgent Emergency Department Visits: Patterns, Demographics, Motivations, and Triage System Awareness in Al-Qassim. Cureus, 16, e58383. https://doi.org/10.7759/cureus.58383 |
| [20] | Turnbull, J., Pope, C., Prichard, J., McKenna, G. and Rogers, A. (2019) A Conceptual Model of Urgent Care Sense-Making and Help-Seeking: A Qualitative Interview Study of Urgent Care Users in England. BMC Health Services Research, 19, Article No. 481. https://doi.org/10.1186/s12913-019-4332-6 |
| [21] | Almulhim, N., Almulhim, F., Al Gharash, A., Alghannam, Z., Al-ghamdi, R.S., Alghamdi, M.H., et al. (2021) Preference for Visiting Emergency Department over Primary Health Care Center among Population in Saudi Arabia. Cureus, 13, e20073. https://doi.org/10.7759/cureus.20073 |
| [22] | Alele, F.O., Emeto, T.I., Callander, E.J. and Watt, K. (2018) Non‐Urgent Paediatric Emergency Department Presentation: A Systematic Review. Journal of Paediatrics and Child Health, 55, 271-277. https://doi.org/10.1111/jpc.14352 |
| [23] | 肖淑娴, 钟迪浩, 陈志强, 等. 广州地区患者就诊选择的影响因素分析[J]. 中国医疗管理科学, 2016, 6(5): 41-45. |
| [24] | Goodridge, D. and Stempien, J. (2018) Understanding Why Older Adults Choose to Seek Non-Urgent Care in the Emergency Department: The Patient’s Perspective. CJEM, 21, 243-248. https://doi.org/10.1017/cem.2018.378 |
| [25] | Ruud, S.E., Hjortdahl, P. and Natvig, B. (2016) Is It a Matter of Urgency? A Survey of Assessments by Walk-In Patients and Doctors of the Urgency Level of Their Encounters at a General Emergency Outpatient Clinic in Oslo, Norway. BMC Emergency Medicine, 16, Article No. 22. https://doi.org/10.1186/s12873-016-0086-1 |
| [26] | Matifary, C.R., Wachira, B., Nyanja, N. and Kathomi, C. (2021) Reasons for Patients with Non-Urgent Conditions Attending the Emergency Department in Kenya: A Qualitative Study. African Journal of Emergency Medicine, 11, 113-117. https://doi.org/10.1016/j.afjem.2020.09.004 |
| [27] | McIntyre, A., Janzen, S., Shepherd, L., Kerr, M. and Booth, R. (2023) An Integrative Review of Adult Patient-Reported Reasons for Non-Urgent Use of the Emergency Department. BMC Nursing, 22, Article No. 85. https://doi.org/10.1186/s12912-023-01251-7 |
| [28] | Wehler, M., Kalch, A., Bilandzic, H. and Händl, T. (2021) [Health Literacy and Nonurgent Emergency Department Visits]. Notfall + Rettungsmedizin, 25, 427-433. https://doi.org/10.1007/s10049-021-00859-z |
| [29] | Smith, R.D. and McNamara, J.J. (1988) Why Not Your Pediatrician’s Office? A Study of Weekday Pediatric Emergency Department Use for Minor Illness Care in a Community Hospital. Pediatric Emergency Care, 4, 107-111. https://doi.org/10.1097/00006565-198806000-00005 |
| [30] | Hitzek, J., Fischer-Rosinský, A., Möckel, M., Kuhlmann, S.L. and Slagman, A. (2022) Influence of Weekday and Seasonal Trends on Urgency and In-Hospital Mortality of Emergency Department Patients. Frontiers in Public Health, 10, Article 711235. https://doi.org/10.3389/fpubh.2022.711235 |
| [31] | Burokienė, S., Raistenskis, J., Burokaitė, E., Čerkauskienė, R. and Usonis, V. (2017) Factors Determining Parents’ Decisions to Bring Their Children to the Pediatric Emergency Department for a Minor Illness. Medical Science Monitor, 23, 4141-4148. https://doi.org/10.12659/msm.902639 |
| [32] | Bornais, J.A.K., Crawley, J. and El-Masri, M.M. (2020) One Stop: Examining the Reasons Patients Use the Emergency Department for Nonurgent Care and the Barriers They Face. Journal of Emergency Nursing, 46, 163-170. https://doi.org/10.1016/j.jen.2019.08.007 |
| [33] | MacKay, J., Atkinson, P., Palmer, E., Fraser, J., Vaillancourt, E., Howlett, M., et al. (2017) Alternate Access to Care: A Cross Sectional Survey of Low Acuity Emergency Department Patients. Cureus, 9, e1385. https://doi.org/10.7759/cureus.1385 |
| [34] | Kraaijvanger, N., Rijpsma, D., Willink, L., Lucassen, P., van Leeuwen, H. and Edwards, M. (2016) Why Patients Self‐refer to the Emergency Department: A Qualitative Interview Study. Journal of Evaluation in Clinical Practice, 23, 593-598. https://doi.org/10.1111/jep.12680 |
| [35] | Tapia, A.D., Cuenca, C.M., Johnson, S.J., et al. (2021) Assessing Challenges with Access to Care for Patients Presenting to the Emergency Department for Non-Emergent Complaints. Medical Journal, 34, 74-80. |
| [36] | Krebs, L.D., Kirkland, S.W., Chetram, R., Nikel, T., Voaklander, B., Davidson, A., et al. (2016) Low-Acuity Presentations to the Emergency Department in Canada: Exploring the Alternative Attempts to Avoid Presentation. Emergency Medicine Journal, 34, 249-255. https://doi.org/10.1136/emermed-2016-205756 |
| [37] | May, M., Brousseau, D.C., Nelson, D.A., Flynn, K.E., Wolf, M.S., Lepley, B., et al. (2018) Why Parents Seek Care for Acute Illness in the Clinic or the ED: The Role of Health Literacy. Academic Pediatrics, 18, 289-296. https://doi.org/10.1016/j.acap.2017.06.010 |
| [38] | Herman, A., Young, K.D., Espitia, D., Fu, N. and Farshidi, A. (2009) Impact of a Health Literacy Intervention on Pediatric Emergency Department Use. Pediatric Emergency Care, 25, 434-438. https://doi.org/10.1097/pec.0b013e3181ab78c7 |
| [39] | McWilliams, D.B., Jacobson, R.M., Van Houten, H.K., Naessens, J.M. and Ytterberg, K.L. (2008) A Program of Anticipatory Guidance for the Prevention of Emergency Department Visits for Ear Pain. Archives of Pediatrics & Adolescent Medicine, 162, 151-156. https://doi.org/10.1001/archpediatrics.2007.30 |
| [40] | Pak, A. and Gannon, B. (2021) Do Access, Quality and Cost of General Practice Affect Emergency Department Use? Health Policy, 125, 504-511. https://doi.org/10.1016/j.healthpol.2021.01.003 |
| [41] | Hong, M., Thind, A., Zaric, G.S. and Sarma, S. (2020) The Impact of Improved Access to After-Hours Primary Care on Emergency Department and Primary Care Utilization: A Systematic Review. Health Policy, 124, 812-818. https://doi.org/10.1016/j.healthpol.2020.05.015 |
| [42] | Gaughan, J., Liu, D., Gutacker, N., Bloor, K., Doran, T. and Benger, J.R. (2022) Does the Presence of General Practitioners in Emergency Departments Affect Quality and Safety in English NHS Hospitals? A Retrospective Observational Study. BMJ Open, 12, e055976. https://doi.org/10.1136/bmjopen-2021-055976 |
| [43] | Kobeissi, M.M. and Hickey, J.V. (2023) An Infrastructure to Provide Safer, Higher-Quality, and More Equitable Telehealth. The Joint Commission Journal on Quality and Patient Safety, 49, 213-222. https://doi.org/10.1016/j.jcjq.2023.01.006 |
| [44] | Alfaleh, A., Alkattan, A., Alageel, A., Salah, M., Almutairi, M., Sagor, K., et al. (2022) The Role of Telemedicine Services in Changing Users’ Intentions for Presenting to the Emergency Departments in Saudi Arabia. Digital Health, 8, 1-8. https://doi.org/10.1177/20552076221091358 |
| [45] | Frazier, S.B., Gay, J.C., Barkin, S., Graham, M., Walsh, M. and Carlson, K. (2022) Pediatric Emergency Department to Primary Care Transfer Protocol: Transforming Access for Patients’ Needs. Healthcare, 10, Article ID: 100643. https://doi.org/10.1016/j.hjdsi.2022.100643 |
