응급실 다방문 환자의 특성 및 관련 요인

Abstract

이 연구는 응급실에 다방문하는 환자의 특성과 관련 요인을 파악하기 위하여 진행하였다. 자료는 응급의료센터급 응급실에서 2019년 1년간 국가응급진료정보망(NEDIS)에 등록한 전수의 진료 정보와 통계청이 제공하는 국가승인통계를 이용하였다. 인구사회학적 특성, 환자 거주지 특성, 진료 특성과 다방문 관련성을 파악하기 위해 다중 로지스틱 회귀분석을 시행하였다. 연구대상자는 총 4,063,640명이었다. 연간 4회 이상 응급실을 방문한 다방문 환자는 137,608명(3.4%)이었으며, 전체 방문 횟수 5,739,671회중 735,502회(12.8%)를 차지하였다. 다방문 가능성은 남성인 경우, 연령이 낮거나 높은 경우(9세 이하, 70세 이상), 보험유형이 의료급여인 경우, 응급의료기관수와 병상수가 전국 평균 미만인 경우, 암·당뇨·신부전·정신질환이 유병인 경우에 높았으며, 응급의료 취약지인 경우, 지역 소득분위가 높은 경우에는 낮았다. 중증도는 5등급(비응급)인 경우 다방문 가능성이 높았으나, 19세 이하는 반대로 1등급(소생)인 경우가 높았다. 고령이나 암, 만성질환, 정신질환자와 같이 의료이용 필요성이 높은 군의 다방문 가능성이 높았고, 저소득이나 지역 간 의료자원 불균형과 같은 의료접근성 요인도 다방문과 관련이 있었다. 효율적인 응급의료체계 구축을 위해 향후 대규모 전향적 코호트 연구 등 보다 심층적인 연구가 필요하다.

This study is to identify the characteristics and factors of frequent users of Emergency Department (ED). This study utilized every medical information that Emergency Departments, which are similar with emergency medical center level, registered into National Emergency Department Information System (NEDIS) in 2019 and nationally approved statistical data that National Statistical Office provided. This study conducted multiple logistic regression analysis to verify the relationship among sociodemographic characteristics, residential characteristics, clinical characteristics, and frequent visits of them. This study selected research subjects with 4,063,640 patients. Among them, 137,608 (3.4%) patients visited ED more than four times in a year. They used ED 735,502 times (12.8%), and the total number of ED usage was 5,739,671. Possibility of the frequent visit was high if patients were male, they were young or old (they were under 9 years old, they were over 70 years old), their insurance type was medical beneficiary, the number of medical institutes and beds were less than national average, and they had cancer, diabetes, renal failure, and mental illness. Possibility of the frequent visit was low if they were in vulnerable areas for emergency medical care and they were in high income regions. The possibility was high if their severity was level 5 (non-emergency), but the possibility was low if they were under 19 years old and their severity was level 1 (resuscitation). The possibility was high if the patients highly needed medical treatment such as they were old, they had cancer, or they have mental illness. Factors of health service accessibility such as low income or medical resource imbalance were related to the frequent visits. In order to establish an efficient emergency medical system, this study presented that more in-depth research should be needed like large-scale prospective cohort research.