Biopsychosocial Health Care Needs at the Emergency Room Challenge of Complexity 英文参考文献.docVIP

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Biopsychosocial Health Care Needs at the Emergency Room Challenge of Complexity 英文参考文献.doc

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Biopsychosocial Health Care Needs at the Emergency Room Challenge of Complexity 英文参考文献

BiopsychosocialHealthCareNeedsattheEmergency Room:ChallengeofComplexity FranziskaMatzer1,UrsulaV.Wisiak1,MonikaGraninger1,WolfgangSo¨llner2,HansPeterStilling1, MonikaGlawischnig-Goschnik1,AndreasLueger3,ChristianFazekas1* 1DepartmentofMedicalPsychologyandPsychotherapy,MedicalUniversityofGraz,Graz,Austria,2DepartmentofPsychosomaticsandPsychotherapy,GeneralHospital Nuremberg,Nuremberg,Germany,3DepartmentofInternalMedicine,MedicalUniversityofGraz,Graz,Austria Abstract Background:Inanemergencyroomofinternalmedicine,triageandtreatmentofpatientsdeservefirstpriority.However, biopsychosocial case complexity may also affect patient health outcome but has not yet been explored in this setting. Therefore,theaimsofthestudyare(1)toestimateprevalenceratesofcomplexpatientsintheemergencyroom(ER),(2)to describebiopsychosocialcomplexityinthispopulationand(3)toevaluatepossiblecorrelationsbetweenpatientprofiles regardingcasecomplexityandfurtherclinicaltreatment. Methods:Duringastudyperiodofoneweek,allpatientsofanemergencyroomofinternalmedicinewhoweretriagedto Manchesterlevelsthreetofivewereinvitedtoparticipateinthestudy.Biopsychosocialcasecomplexitywasassessedbythe INTERMED method. Psychosocial interventions were evaluated based on all documented interventions and recommen- dationsgivenattheemergencyroomandduringinpatienttreatment. Results: Study participants consisted of 167 patients with a subgroup of 19% (n=32) receiving subsequent inpatient- treatment at the department. High biopsychosocial case complexity was found in 12% (n=20) of the total sample (INTERMEDscore.20).Thisfindingwasparalleledbyaclusteranalysissuggestingthreeclusterswithonehighlycomplex patientgroupof14%.Thesehighlycomplexpatientsdifferedsignificantlyfromtheotherclustersastheyhadvisitedthe emergencyroommoreoftenwithinthelastyearandlivedalonemorefrequently.Inaddition,admissionrateswerehighest in this group. During ER treatment and subsequent inpatient treatment, 21% of highly complex patients received interventions