Behandlungsdringlichkeit aus ärztlicher und Patientensicht - eine prospektive vergleichende Querschnittsstudie an gynäkologisch-internistischen Notfallambulanzen von drei Berliner Innenstadtkliniken

Abstract

Purpose: To gain an understanding and interpret similarities/ discrepancies between the patients' and the physicians' assessment of the urgency of treatment and corresponding factors influencing assessment in emergency departments. Methods: Cross-sectional study in three emergency departments in Berlin (gynecological and internal medicine) between 11/2001 and 4/ 2002: 1) 30-minute guided interviews (72 questions) inquiring into socio-demographic data (e.g. age, sex, ethnicity, educational and social status, ailments, psycho-social situation, migrational background of the patient, details on the current illness, urgency of treatment as well as medical treatment received before); 2) Short questionnaire for physicians of the emergency department (evaluation of the linguistic communication, the doctor-patient relation and the urgency of treatment/same scale as used for patients). Results: The patients' assessment of the urgency of treatment ranked significantly higher than the corresponding assessment of the physicians (median 7 vs. 5 with similar distribution; range 0-10). Patients with Turkish migration background ranked their presented health situation as requiring more urgent treatment than German patients (p<0.07). In principle there is only a marginal congruence in the assessments (in 52% the physician rated the urgency lower and in 10% higher than the patients themselves). Only the estimated quality of the doctor-patient relation showed a significant systematic correlation with the differences in the assessments. The worse the physicians rated the doctor-patient relation, the stronger was the deviation in the urgency assessment on both sides and the lower was the physicians' categorization. The determinants ethnicity, estimated quality of linguistic communication and sex of the physician and the patient had no significant impact on accordance. Conclusion: The assessment of what is an emergency substantially differs between patients and physicians. For healthcare in emergency departments that satisfies demand, the physicians' view as well as the patients' perspective need to be considered.