Overestimation of health urgency as a cause for emergency services inappropriate use: Insights from an exploratory economics experiment in Portugal

Abstract

Increasing visits to emergency departments add strain to public healthcare systems.The misperception of symptoms' severity can partly explain inappropriate use of hospitals' emergency departments by non-urgent patients. This paper focuses on the misperception of symptoms' severity as a cause for the inappropriate use of emergency departments. It explores the role that informing potential patients of the correct severity level can play in correcting this inefficiency. We implement in an incentivised manner an exploratory economic experiment to elicit the degree of severity of five sets of symptoms, corresponding to frequent causes of emergency department visits. The study was setup in Braga, Northern Portugal, recruiting voluntary participants through civic local organisations. We ask participants to indicate the more suitable health service, before and after revealing the true degree of severity. Results show that there is an overestimation of the degree of severity of some clinical profiles, and when confronted with the real severity, in only half of the cases are choices changed to other health services.Although exploratory, this study provides insights into the potential role of health education policies concerning symptoms' severity but it also highlights the limits of such policies. Furthermore, the use of economic experiments can provide meaningful insights for the design of policies addressing demand-side healthcare inefficiencies. K E Y W O R D S economic experiment, elicitation of beliefs, emergency department demand, health services research, healthcare economics and organizations, non-urgent patients

Potential of a nurse telephone triage line to direct elderly to appropriate health care settings

“…Assuming nurses' dispositions were appropriate and safe, the results of this study indicate that elders tend to overestimate the degree of severity of their symptoms, and nurses can adjust perceptions of the symptom's severity. Similar results were reported for the general Portuguese population (Botelho et al, ). The authors showed that the tendency to overestimate the degree of severity helps to explain the over demand for A&E care.…”

When fear backfires: Emergency department accesses during the Covid-19 pandemic

“…[ [1] , [2] , [3] ]. The change in demand composition [ 4 , 5 ] supply shortages, availability of primary or community care services [ [6] , [7] , [8] , [9] ], strategic behaviour [ [10] , [11] , [12] ], overestimation of health needs [ 13 ] may be responsible for this increase, which is also the signal of the importance and the confidence that patients attach to ED services. The Coronavirus disease (Covid-19) outbreak has created a major disruption in health care delivery, both for patients that were infected and for those that were not treated because of the pandemic [ 14 ].…”

Usuários adultos classificados como pouco urgentes em Unidade de Pronto Atendimento

“…A busca de atendimento com situações pouco urgentes é um achado comum, sendo verificado em vários estudos [9][10][11][12]22 . Quando observamos a totalidade dos atendimentos do serviço em estudo, 72,59% dos usuários receberam a classificação de risco pouco urgente, um percentual maior do que a média geral de todos os prontos atendimentos de Porto Alegre, sendo de 63,06% em 2015 e 66,8% em 2016, que receberam esta mesma classificação, segundo o protocolo de Manchester 6 .…”

“…A utilização excessiva das emergências está ligada a uma questão cultural, relacionando-se também, entre outros fatores, à qualidade da atenção oferecida; assim, conhecer a demanda é uma ação necessária para melhorar ainda mais a resolutividade desses serviços 8 . Vários estudos demonstram que serviços de urgência e emergência ainda servem de porta de entrada ao sistema, mesmo em situações pouco urgentes ou não consideradas urgências médicas [8][9][10][11] . A dificuldade de acesso à assistência nos serviços de Atenção Básica, a não viabilidade das contrarreferências e a falta de leitos hospitalares são alguns dos indutores de superlotação nas emergências 12 .…”