Patients’ preferences over care settings for minor illnesses and injuries

Abstract

Objectives To identify consumers’ preferences over care settings, such as physicians’ offices, emergency rooms (ERs), urgent care centers, retail clinics, and virtual physicians on smartphones, for minor illnesses. Data Sources A survey conducted between 9/27/16 and 12/7/16 emailed to all University of California, Irvine employees. Study Design Participants were presented with 10 clinical scenarios and asked to choose the setting in which they wanted to receive care. We estimated multinomial conditional logit regression models, conditioning the choice on out‐of‐pocket costs, wait time, travel time, and chooser characteristics. Data Collection 5451 out of 21 037 employees responded. Principal findings Out‐of‐pocket costs and wait time had minimal impact on patient's preference for site of care. Choices were driven primarily by the clinical scenario and patient characteristics. For chronic conditions and children's well‐visits, the doctor's office was the preferred choice by a strong majority, but for most acute conditions, either the ER (for high severity) or urgent care clinics (for lower severity) were preferred to the office setting, particularly among younger patients and those with less education. Conclusions Patients have several alternatives to traditional physicians’ offices and ERs. The low impact of out‐of‐pocket costs suggests that insurers interested in encouraging increased utilization of alternatives would need to consider substantial changes to benefit structure.

Quanto custa uma consulta médica especializada para as famílias de pacientes pediátricos no Sistema Único de Saúde?

“…Especificamente para cirurgia pediátrica, Laferriere et al 3 sugerem que apenas 1/3 das consultas presenciais em cirurgia pediátrica poderiam ser substituídas por consultas a distância. Os pacientes tendem a hierarquizar a importância do problema que apresentam, distribuindo o método de atendimento aceitável de acordo com essa estrutura, de forma que a aceitação do método varia: o nível de gravidade e urgência parecem ser mais importantes do que o custo, tempo de espera e necessidade de deslocamento 21 . A aceitação de consultas cirúrgicas para seguimento por telemedicina é maior do que para consultas para diagnóstico e planejamento terapêutico 19 .…”

Firework injuries are increasing in the United States: An analysis of the National Emergency Department Sample

“…19 An alternative explanation for the increased proportion of severe injuries seen in hospital EDs is that patients with less severe injuries may self-triage to urgent care centers (UCCs), and access to UCCs is increasing. 31,32 Given the high rate of ocular and hand trauma, a lack of access to specialty care may also drive increased visits to tertiary hospitals. A survey from Florida indicated that only 7% of rural EDs and 61% of nonrural EDs have ophthalmology call coverage.…”

“…Rudisill et al found that the number of injuries increased at their trauma center in West Virginia after regulations of consumer fireworks were relaxed in the state, but there was no increase in the severity of injuries 19 . An alternative explanation for the increased proportion of severe injuries seen in hospital EDs is that patients with less severe injuries may self‐triage to urgent care centers (UCCs), and access to UCCs is increasing 31,32 …”