Experience of being a frequent user of primary care and emergency department services: a qualitative systematic review and thematic synthesis

Abstract

BackgroundFrequent users of healthcare services are often categorised as ‘heavy-cost patients’. In the recent years, many jurisdictions have attempted to implement different public policies to optimise the use of health services by frequent users. However, throughout this process, little attention has been paid to their experience as patients.ObjectiveTo thematically synthesise qualitative studies that explore the experience of frequent users of primary care and emergency department services.DesignQualitative systematic review and thematic synthesis.SettingPrimary care and emergency department.ParticipantsFrequent users of primary care and emergency department services.MethodsA qualitative systematic review was conducted using three online databases (MEDLINE with full text, CINAHL with full text and PsycINFO). This search was combined to an extensive manual search of reference lists and related citations. A thematic synthesis was performed to develop descriptive themes and analytical constructs.Study selectionTwelve studies were included. All included studies met the following inclusion criteria: qualitative design; published in English; discussed frequent users’ experiences from their own perspectives and users’ experiences occurred in primary care and/or emergency departments.ResultsThe predominant aspects of frequent users’ experiences were: (1) the experience of being ill and (2) the healthcare experience. The experience of being ill encompassed four central themes: physical limitations, mental suffering, impact on relationships and the role of self-management. The healthcare experience embraced the experience of accessing healthcare and the global experience of receiving care.ConclusionThis synthesis sheds light on potential changes to healthcare delivery in order to improve frequent users’ experiences: individualised care plans or case management interventions to support self-management of symptoms and reduce psychological distress; and giving greater importance on the patient–providers relationship as a central facet of healthcare delivery. This synthesis also highlights future research directions that would benefit frequent users.

Potential Help-Seeking Behaviors Associated with Better Self-Rated Health among Rural Older Patients: A Cross-Sectional Study

“…Although the concrete process of HSB varies, if they follow the potential HSB of using both types of care that fit their symptoms, their health conditions can be improved [35]. A previous review shows that the usage of primary care and emergency medicine can be related to patients' perspectives of being ill and their experiences in healthcare, which can be affected by patients' and regional medical contexts [36]. For the moderation of HSB, these sensitive factors should be respected for the establishment of interventions for HSBs.…”

Understanding the experience in the healthcare system of non-migrant and migrant frequent users of the emergency department in French-speaking Switzerland: a comparative qualitative study

“…For patients who do not yet have an established diagnosis, multiple consultations can also be the source of an additional feeling of apprehension when visiting the ED. 35 The uncertainty regarding the cause of their pathology may have further exacerbated patients’ feelings of anxiety and anguish already heightened by their pain. The psychological and social impacts of symptoms often mentioned may also have been the main undisclosed reason for some consultations.…”

Paediatric frequent use of emergency medical services: a systematic review

“…More broadly, deprivation is strongly associated with increased levels of chronic conditions among children such as diabetes and asthma 41 42. These silences may reflect the limited datasets used in the included studies which typically relied on retrospective routinely collected data, rather than the qualitative approaches that are beginning to examine adult frequent use in greater detail 3 4 43. There is therefore a clear need to understand whether there is an association between frequent use and markers of inequality such as socioeconomic status or deprivation using prospective methods.…”