Demand for emergency health service: factors associated with inappropriate use

Carret, Maria Laura Vidal; Fassa, Anaclaudia Gastal; Kawachi, Ichiro

doi:10.1186/1472-6963-7-131

Cited by 185 publications

(227 citation statements)

References 28 publications

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“…identified younger people tended to choose emergency and urgent care over general practice. Young females were identified in a Brazilian study as being more likely to use ED inappropriately, due to lack of access to primary care services 49. Migrant populations often had no PCP and often sought ED care for nonurgent health problems due to difficulties accessing primary healthcare 50…”

Section: Resultsmentioning

confidence: 99%

“…Access to primary care is often viewed as limited, due to more structured opening hours and perceptions around difficulty obtaining appointments, and there is a view that the ED is more convenient due to factors such as 24‐hour availability and not having to make an appointment 38, 43, 49, 55, 62. In one study, 60% of patients viewed the ED as more convenient than their PCP55 and several other studies reported that people chose to visit the ED for low‐urgency problems due to ED being closer or faster,63 the accessibility of the ED,43, 54 the convenience of the ED location,42 or service 40.…”

Section: Resultsmentioning

confidence: 99%

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Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis

Coster

Turner

Bradbury

et al. 2017

Academic Emergency Medicine

253

217

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ObjectivesRising demand for emergency and urgent care services is well documented, as are the consequences, for example, emergency department (ED) crowding, increased costs, pressure on services, and waiting times. Multiple factors have been suggested to explain why demand is increasing, including an aging population, rising number of people with multiple chronic conditions, and behavioral changes relating to how people choose to access health services. The aim of this systematic mapping review was to bring together published research from urgent and emergency care settings to identify drivers that underpin patient decisions to access urgent and emergency care.MethodsSystematic searches were conducted across Medline (via Ovid SP), EMBASE (via Ovid), The Cochrane Library (via Wiley Online Library), Web of Science (via the Web of Knowledge), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; via EBSCOhost). Peer‐reviewed studies written in English that reported reasons for accessing or choosing emergency or urgent care services and were published between 1995 and 2016 were included. Data were extracted and reasons for choosing emergency and urgent care were identified and mapped. Thematic analysis was used to identify themes and findings were reported qualitatively using framework‐based narrative synthesis.ResultsThirty‐eight studies were identified that met the inclusion criteria. Most studies were set in the United Kingdom (39.4%) or the United States (34.2%) and reported results relating to ED (68.4%). Thirty‐nine percent of studies utilized qualitative or mixed research designs. Our thematic analysis identified six broad themes that summarized reasons why patients chose to access ED or urgent care. These were access to and confidence in primary care; perceived urgency, anxiety, and the value of reassurance from emergency‐based services; views of family, friends, or healthcare professionals; convenience (location, not having to make appointment, and opening hours); individual patient factors (e.g., cost); and perceived need for emergency medical services or hospital care, treatment, or investigations.ConclusionsWe identified six distinct reasons explaining why patients choose to access emergency and urgent care services: limited access to or confidence in primary care; patient perceived urgency; convenience; views of family, friends, or other health professionals; and a belief that their condition required the resources and facilities offered by a particular healthcare provider. There is a need to examine demand from a whole system perspective to gain better understanding of demand for different parts of the emergency and urgent care system and the characteristics of patients within each sector.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis

Coster

Turner

Bradbury

et al. 2017

Academic Emergency Medicine

253

217

View full text Add to dashboard Cite

show abstract

“…We identified two standardized criteria for defining inappropriate use: (i) the Canadian Triage and Acuity Scale (CTAS) 12 , which classifies ED care in five levels, based on the waiting time allowed for the patient to be examined by the physician, risk of death, vital signs, pain level, possibility of complications, and origin of the injury and (ii) the Hospital Urgencies Appropriateness Protocol (PAUH) 13,14,15,16 , defining the case as urgent whenever one of the items evaluated was met. This protocol considers criteria of severity (for example, altered vital signs and active hemorrhages), diagnosis (like orders for laboratory or imaging tests), treatment (like need for IV medication), and origin of the need for seeking the ED (for example: coming directly from a traffic accident or symptoms suggesting vital urgency) (Table 1).…”

Section: Criteria For Defining Inappropriate Ed Usementioning

confidence: 99%

“…Prevalence of inappropriate ED use varied from 10 to 90%, based on the criterion used, and in nearly half of the studies it varied from 24 to 40% 6,12,13,14,16,17,18,19,20,21,22,23,24,25,26 . All these articles presented similar criteria, evaluating the number of hours the patient could wait without risk of death, need for tests or treatments, need for hospitalization, possibility of treatment at another level of care, and observation time (Table 1).…”

Section: Prevalencementioning

confidence: 99%

“…As for time of arrival at the ED, the early morning hours (midnight to 08:00 AM) was the period with the most appropriate ED use 13,14,21,22,23,28 , while the morning and afternoon shifts showed the heaviest ED use by patients with inappropriate complaints 13,21 . Day of the week was not associated with inappropriate use 12,14,22,37 .…”

Section: Characteristics Of Inappropriate Ed Usementioning

confidence: 99%

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Inappropriate use of emergency services: a systematic review of prevalence and associated factors

2009

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This systematic review aimed to measure the prevalence of inappropriate emergency department (ED) use by adults and associated factors. The review included 31 articles published in the last 12 years. Prevalence of inappropriate ED use varied from 20 to 40% and was associated with age and income. Female patients, those without co-morbidities, without a regular physician, without a regular source of care, and those not referred to the ED by a physician also showed more inappropriate ED use, with the relative risk varying from 1.12 to 2.42. Difficulties in accessing primary health care (difficulties in setting appointments, longer waiting periods, and short business hours at the primary health care service) were also associated with inappropriate ED use. Thus, primary care requires fully qualified patient reception and efficient triage to promptly attend cases that cannot wait. It is also necessary to orient the population on situations in which they should go to the ED and on the disadvantages of consulting the ED when the case is not really urgent.

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Investigating inappropriate admissions and hospitalizations in Yasuj educational hospitals based on appropriateness evaluation protocol (AEP): A case study in the internal and surgical wards

Rahimi

Ostovar

Vali

et al. 2019

Health Planning & Management

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Summary Background Examining the conditions for hospital admission and its appropriateness, and continuous investigation of hospital services are important issues that can improve resource productivity, service quality, and hospital efficacy. So, the present study was conducted to determine the appropriateness of the services provided in Yasuj educational hospitals. Methods This descriptive‐analytical study was carried out on 204 hospitalized patients who were selected through multistage quota sampling in 2016. The appropriateness evaluation protocol (AEP) was used to collect the data. Analytical tests such as paired t‐test, chi‐square test, and Fisher's exact test were used to determine the relationship between appropriate and inappropriate admission and hospitalization and demographic characteristics. The data were analyzed using the SPSS18 statistical software. Results A total of 980 days of stay were evaluated, and according to the AEP, 35 days of hospitalization were considered inappropriate (3.57%). The mean hospitalization duration was 6/16 ± 5/53 days. The results showed that inappropriate admission and hospitalization rates were respectively 0.6% and 13.8%. Conclusion Unnecessary admissions and hospitalizations can be considered as one of the challenges of the health system. Reducing unnecessary hospitalization will increase hospital productivity, reduce the waiting list and hospitalization costs, and also reduce the risk of exposure to hospital infections. In order to prevent inappropriate admissions and unnecessary hospitalizations, special measures can be taken, including the use of clinical guidelines, modification of the discharge process, and modification of the lower levels of the service providing system.

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Demand for emergency health service: factors associated with inappropriate use

Cited by 185 publications

References 28 publications

Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis

Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis

Inappropriate use of emergency services: a systematic review of prevalence and associated factors

Investigating inappropriate admissions and hospitalizations in Yasuj educational hospitals based on appropriateness evaluation protocol (AEP): A case study in the internal and surgical wards

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