Læknablaðið - 15.10.1980, Page 4

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LÆKN ABLADID
NÝR DOKTOR í LÆKNISFRÆÐIGUÐJÓN MAGNÚSSON
Hinn 28. apríl 1980 varði Guðjón Magnússon
doktorsritgerð við Karolinska Institutet í
Svíþjóð. Ritgerðin nefnist Excessive Use of
Medical Care or Rational Patient Behaviour?
A study of a Large Hospital Emergency
Department. Útdráttur úr ritgerðinni fer hér á
eftir:
The thesis was defended on April 28, 1980 at
the Huddinge Hospital by Gudjon Magnus-
son, Department of Social Medicine, Huddin-
ge University Hospital, S-141 86 Huddinge,
Sweden.
The role of hospital emergency depart-
ments has over the years been gradually
extended, especially in large urban areas. In
Stockholm, visits to hospital emergency de-
partments increased by 30 per cent between
1973 og 1977. The southwestern district, one
of Stockholm’s five health care districts, has
had the highest visiting rates — since 1975 40
per cent above average. A large university
hospital, the Huddinge Hospital, was opened
in this district in 1972.
The study is an inquiry into the use of the
Huddinge Hospital emergency department by
the population in its catchment area. The
study encompassed not only those who used
the emergency department but an approxima-
tely 10 per cent sample (17 004 people) of the
population. Data was collected from the
hospital emergency department, medical re-
cords, by interviews with users and non-users
and from registers.
During the 15 months’ observation (January
1976 to March 1977) 29 per cent of the
population visited the hospital emergency
department (range for different subareas 22 to
46 per cent). The total number of visits was
566 per 1 000 population.
Compared with Swedish citizens, immi-
grants more often visited the emergency
department (19 per cent more visits) but less
often used the hosþital outpatient clinics.
Marked differences between Swedes and im-
migrants were found in illness behaviour.
The role of proximity in the use of the
hospital emergency department was analýsed
by dividing the catchment area into 20 subare-
as. The subareas closer to the hospital had up
to four times higher visiting rates compared
with areas further away. The travelling distan-
ce to the hospital and the proportion of
immigrants together explained 81 per cent of
the differences in visiting rates between the
subareas.
In one geographically defined subarea, 15
per cent of the population visited district GPs
while 30 per cent visited the hospital emer-
gency department. An estimated 39 to 64 per
cent of the visits to the hospital emergency
department were general practitioner-type
cases.
In a representative sample of users and
non-users of the emergency department,
strong association was found between health
status, social factors and the level of use of the
emergency department.
The hospital emergency department is a
major source of medical care for the populati-
on in the catchment area. A considerable part
of its diversified role is to compensate for the
low capacity of the primary care services in
the area.