Decision-Making Processes of Patients Who Use the Emergency Department for Primary Care Needs

Shaw, Eric K.; Howard, Jenna; Clark, Elizabeth; Etz, Rebecca; Arya, Rajiv; Tallia, Alfred F.

doi:10.1353/hpu.2013.0140

Cited by 49 publications

(73 citation statements)

References 58 publications

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“…Similar to the findings of previous studies, (22) the present study showed that paediatric ED attendance for nonurgent conditions involves the caregiver's assessment of the benefits and disadvantages of attending an ED compared to visiting a primary care provider. The results of our study confirm previous findings that caregivers are heavily influenced by the perceived severity of the disease in the child when deciding on where to go for medical care.…”

Section: Discussionsupporting

confidence: 88%

Understanding decisions leading to nonurgent visits to the paediatric emergency department: caregivers’ perspectives

Kua

Ong

et al. 2016

smedj

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INTRODUCTIONThe use of the emergency department (ED) for nonurgent care is a worldwide concern.(1-5) Singapore, the most economically developed country in Southeast Asia, is no exception. In 2013, approximately 60% of visits to the paediatric ED of KK Women's and Children's Hospital (KKH), Singapore, were for nonurgent conditions. Nonurgent use of the ED leads to overcrowding, long waiting periods, increased costs, high staff burden, caregiver dissatisfaction and lower quality of care for patients requiring urgent care.(6-8) Therefore, understanding the factors related to nonurgent ED use is paramount and may have far-reaching impact.A constellation of variables influences caregivers' decision to attend paediatric EDs. Previous studies on caregivers' perspectives revealed perceived need as a common reason; this perceived need is related to the perceived severity of the child's illness, (7,(9)(10)(11)(12)(13) the need to seek assurance on the course of the illness (7) and the expectation that medical tests, such as radiography, will be needed. (7,10,13) Caregivers' perceptions of primary healthcare providers are also a key contributing factor to the nonurgent use of paediatric EDs. Several studies indicated that caregiver dissatisfaction with primary healthcare providers was due to accessibility and scheduling issues, (9)(10)(11) as well as the perception that the quality of care given by primary healthcare providers is lower than that given at the ED. (14) In addition, overseas studies have indicated that factors such as insurance coverage and welfare are related to nonurgent paediatric ED attendance. (9,15) In the Behavioural Model of Health Services Use, (16) Andersen suggested that the use of health services is shaped by the interaction between individual characteristics and contextual factors (e.g. health services and policies). Singapore has a network of primary healthcare providers consisting of 18 government polyclinics and approximately 1,500 private general practitioner (GP) clinics. (17) Primary care professionals are usually the first point of contact for patients, and if needed, can refer them to medical specialists and hospitals. The healthcare financing system in Singapore espouses the philosophies of individual responsibility and affordable healthcare for all. The government subsidises low-income families, citizens and permanent residents seeking care in the public sector. (18) While previous studies and theoretical frameworks provide some insight into the factors related to the nonurgent use of paediatric EDs, this issue has not been explored in a Southeast Asian population. Thus, the present study aimed to qualitatively explore questions on paediatric ED attendance from the perspective of caregivers who presented at KKH, a large public children's hospital. The findings of this study may be used to develop effective and targeted interventions to reduce unnecessary paediatric ED attendance.

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Section: Discussionsupporting

confidence: 88%

Understanding decisions leading to nonurgent visits to the paediatric emergency department: caregivers’ perspectives

Kua

Ong

et al. 2016

smedj

View full text Add to dashboard Cite

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“…On the other hand, the youngest seem to by-pass primary care physicians in order to receive a prompt high-tech, complex evaluation, and diagnosis, thus contributing to the inefficiency of the system. These results are in line from other evidences belonging to the recent literature, that has found various, complex reasons for patients to refer to the ED [37], and may support the findings related to the accessibility/convenience of ED as a valid reason for self-referral of patients [36]. Finally, those results may suggest the importance of a redesign of primary care in Italy.…”

Section: Discussionsupporting

confidence: 91%

Emergency Department Non-Urgent Visits and Hospital Readmissions Are Associated with Different Socio-Economic Variables in Italy

et al. 2015

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ObjectiveThe aim of this paper was to evaluate socio-economic factors associated to poor primary care utilization by studying two specific subjects: the hospital readmission rate, and the use of the Emergency Department (ED) for non-urgent visits.MethodsThe study was carried out by the analysis of administrative database for hospital readmission and with a specific survey for non-urgent ED use.ResultsAmong the 416,698 sampled admissions, 6.39% (95% CI, 6.32–6.47) of re-admissions have been registered; the distribution shows a high frequency of events in the age 65–84 years group, and in the intermediate care hospitals (51.97%; 95%CI 51.37–52.57). The regression model has shown the significant role played by age, type of structure (geriatric acute care), and deprivation index of the area of residence on the readmission, however, after adjusting for the intensity of primary care, the role of deprivation was no more significant. Non-urgent ED visits accounted for the 12.10%, (95%CI 9.38–15.27) of the total number of respondents to the questionnaire (N = 504). The likelihood of performing a non-urgent ED visit was higher among patients aged <65 years (OR 3.2, 95%CI 1.3–7.8 p = 0.008), while it was lower among those perceiving as urgent their health problem (OR 0.50, 95%CI 0.30–0.90).ConclusionsIn the Italian context repeated readmissions and ED utilization are linked to different trajectories, besides the increasing age and comorbidity of patients are the factors that are related to repeated admissions, the self-perceived trust in diagnostic technologies is an important risk factor in determining ED visits. Better use of public national health care service is mandatory, since its correct utilization is associated to increasing equity and better health care utilization.

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“…20,21 Issues such as the need for after-hours care, transportation, and provider cancellations can hinder patients' efforts to access primary care. For instance, a provider cancellation rate of 15% sends the wrong message to an already skeptical and vulnerable group of patients.…”

Section: Discussionmentioning

confidence: 99%

Connecting Emergency Department Patients to Primary Care

Wexler

Hefner

Sieck

et al. 2015

The Journal of the American Board of Family Medicine

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Background: Inappropriate emergency department (ED) use among Medicaid enrollees is considered a problem because of cost. We developed and evaluated a system change innovation designed to remove system barriers to primary care access for Medicaid patients.Methods: Patients who presented to the ED without an identified primary care provider were randomized to the intervention (n ‫؍‬ 72) or comparison group (n ‫؍‬ 68) for a 12-month study designed to connect these patients to primary care offices. Evaluation was mixed quantitative/qualitative.Results: Significantly more intervention participants attended at least 1 primary care visit 3 months after the intervention (odds ratio [

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Decision-Making Processes of Patients Who Use the Emergency Department for Primary Care Needs

Cited by 49 publications

References 58 publications

Understanding decisions leading to nonurgent visits to the paediatric emergency department: caregivers’ perspectives

Understanding decisions leading to nonurgent visits to the paediatric emergency department: caregivers’ perspectives

Emergency Department Non-Urgent Visits and Hospital Readmissions Are Associated with Different Socio-Economic Variables in Italy

Connecting Emergency Department Patients to Primary Care

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