Evaluation of the use of services provided by emergency care units in a Brazilian municipality

ABSTRACT Objective: To characterize the users and to analyze the factors that determine their choice in using the emergency services. Methods: The study was carried out in the two Emergency Care Units in Serra (Espírito Santo, Brazil). With regard to those users seeking the services of these Emergency Care Units, a trained interviewer approached 1 out of every 4 adults classified in the nursing consultation as not relevant to the Service ("false demand"), amounting to a total of 390 interviews. Using a validated questionnaire, the interview was conducted in accordance with the policies set out in the Health Service Action Plan. 80% of the demand was classified as not relevant. Results: The "false demand" was chiefly composed of women (55.1%), educated to a level between high school and incomplete higher education (69.4%) and 14.6% were enrolled in private health plans. 78.5% had not previously sought any health service, in view of the ostensible guarantee of same-day care (43.1%) or the difficulty in receiving care in the basic health units (37.9%). Conclusion: The majority of consultations performed in the Emergency Care Units should be resolved in basic healthcare facilities. The "false demand" is related to the reported difficulties the basic health units have in providing the necessary care and their ability to resolve the problem.

摘要
研究目的：本研究旨在明确急诊服务使用者的特征，并分析影响其选择急诊服务的相关因素。
研究方法：本研究在巴西圣埃斯皮里图州塞拉市的两家急诊护理单元（Emergency Care Units）开展。针对前来就诊的急诊护理单元使用者，经过培训的调查员按每4名抽取1名的比例，选取经护理评估判定为非必需就诊（即“假性需求（false demand）”）的成年人进行访谈，最终累计完成390份访谈。本研究采用经过信效度检验的调查问卷，严格遵循《卫生服务行动计划》规定的流程开展访谈。本次研究中，80%的就诊需求被判定为非必需就诊。
研究结果：假性需求人群以女性为主（占比55.1%），学历多为高中至高等教育在读或肄业阶段（占比69.4%），另有14.6%的人群参保了私人医疗保险。其中78.5%的人群此前未寻求过任何医疗服务，选择急诊就诊的主要动因包括可享受当日就诊的承诺（43.1%）以及基层医疗卫生机构就诊难度大（37.9%）。
研究结论：急诊护理单元接诊的多数诊疗需求本可在基层医疗卫生机构得到解决。假性需求的产生与基层医疗卫生机构无法提供必要诊疗服务、难以解决患者健康问题的现状密切相关。