※ [本文转录自 Gossiping 看板] 作者: explosion (爆炸) 看板: Gossiping 标题: [爆卦] 国民们! 你们将来背负的医疗负债更重了 时间: Sat Apr 4 09:42:16 2009 美国已经注意到这个问题了, 再人口结构老化将近是全球第一的台湾, 我们的疗系统是否有所准备? 他山之石, 可以大略了解, 到底谁才是使医疗保健财政日渐窘迫的首要因素? 若不改革制度 仅是继续追讨欠款 or 增加人民保费 完全无益於克服显而易见而且紧迫逼人的健康人口改变 ---------------------- The Growing Older Population’s Effect on Emergency Care 日渐成长的老人族群对於急诊医疗照顾的冲击 — Richard D. Zane, MD, FAAEM 理查赞恩 医师 美国急诊医学会会员 ED visit rates among patients aged 65 to 74 increased 34% from 1993 to 2003. 从1993到2003年, 65岁到74岁年纪群的急诊病人来诊量, 增加了34% Among the many factors thought to contribute to emergency department overcrowding are an increase not only in the number of patients but also in the complexity of cases. Older patients are a challenge because they typically require more-complex evaluations, have longer ED length of stays, and have higher rates of hospitalization than do younger patients. 不仅仅是病人数量, 而且病情的复杂度增加, 都导致了急诊的过度拥挤. 相对於年轻病 人, 老年病人需要更繁复的检查, 有较长的急诊留观时间, 也有较高的住院机率. These authors used data from the National Hospital Ambulatory Medical Care Survey to determine trends in ED visit rates for patients older than 65 from 1993 to 2003. During the study period, ED visits for patients aged 65 to 74 increased 34%; visits for patients older than 74 did not increase significantly. Visit rates increased 93% for black patients and 26% for white patients. Visit-rate increases were similar for men and women. Based on the number of medications administered and admission rate as an indirect gauge of visit complexity, the number of visits in which three or more medications were prescribed increased 44%, whereas the admission rate did not change significantly (although it varied year to year). On the basis of these data, the authors estimate that ED visits in the U.S. among patients aged 65 to 74 will double from 6.4 million to 11.7 million by 2013. 这些作者使用来自於National Hospital Ambulatory Medical Care Survey的资料来决 定1993到2003年, 65岁以上的急诊病人量. 65-74岁的病人数增加了34%; 大於74岁以 上的病人比例没有明显增加. 黑人病人量增加了93%, 白人增加了26%. 男性与女性病人 比例差不多. 用给予不同药物的数量, 还有住院比例来间接评估病情的复杂度而言, 开立三种以上药物的病人数量增加了44%, 然而住院比例并没有明显增加 (虽然每年 不大相同). 根据以上资料, 作者评估到达2013年, 65-74岁的急诊病人族群会从640 万人增加到1170万人次. Comment: Persons older than 65 are the fastest growing demographic in the U.S. Planning for delivery of healthcare for the entire population must address the effect that this growing older population will have on the provision of emergency care. The solution will have to involve more than just building bigger EDs because the increased burden will involve not only the number of patients seeking emergency care but also the complexity of cases. 评语: 65岁以上的老人是美国急诊病人中增加最快速的族群. 计画给予全体国人医疗 照顾的同时, 也必须强调这个老人族群数量的增加, 会对急诊医疗照顾所带来的冲击. 解决之道不仅仅是盖更大的急诊, 因为除了病人量的增加, 也包括病情复杂度的增加. 引用期刊: Roberts DC et al. Increasing rates of emergency department visits for elderly patients in the United States, 1993 to 2003. Ann Emerg Med 2008 Jun; 51:769. --

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