Sense-making strategies and help-seeking behaviours associated with urgent care services: a mixed-methods study

Abstract

BackgroundPolicy has been focused on reducing unnecessary emergency department attendances by providing more responsive urgent care services and guiding patients to ‘the right place’. The variety of services has created a complex urgent care landscape for people to access and navigate.ObjectivesTo describe how the public, providers and policy-makers define and make sense of urgent care; to explain how sense-making influences patients’ strategies and choices; to analyse patient ‘work’ in understanding, navigating and choosing urgent care; to explain urgent care utilisation; and to identify potentially modifiable factors in decision-making.DesignMixed-methods sequential design.SettingFour counties in southern England coterminous with a NHS 111 provider area.MethodsA literature review of policy and research combined with citizens’ panels and serial qualitative interviews. Four citizens’ panels were conducted with the public, health-care professionals, commissioners and managers (n = 41). Three populations were sampled for interview: people aged ≥ 75 years, people aged 18–26 years and East European people. In total, 134 interviews were conducted. Analyses were integrated to develop a conceptual model of urgent care help-seeking.FindingsThe literature review identified some consensus between policy and provider perspectives regarding the physiological factors that feature in conceptualisations of urgent care. However, the terms ‘urgent’ and ‘emergency’ lack specificity or consistency in meaning. Boundaries between urgent and emergency care are ill-defined. We constructed a typology that distinguishes three types of work that take place at both the individual and social network levels in relation to urgent care sense-making and help-seeking.Illness workinvolves interpretation and decision-making about the meaning, severity and management of physical symptoms and psychological states, and the assessment and management of possible risks. Help-seeking was guided bymoral work: the legitimation and sanctioning done by service users.Navigation workconcerned choosing and accessing services and relied on prior knowledge of what was available, accessible and acceptable. From these empirical data, we developed a model of urgent care sense-making and help-seeking behaviour that emphasises that work informs the interaction between what we think and feel about illness and the need to seek care (sense-making) and action – the decisions we take and how we use urgent care (help-seeking).LimitationsThe sample population of our three groups may not have adequately reflected a diverse range of views and experiences. The study enabled us to capture people’s views and self-reported service use rather than their actual behaviour.ConclusionsMuch of the policy surrounding urgent and emergency care is predicated on the notion that ‘urgent’ sits neatly between emergency and routine; however, service users in particular struggle to distinguish urgent from emergency or routine care. Rather than focusing on individual sense-making, future work should attend to social and temporal contexts that have an impact on help-seeking (e.g. why people find it more difficult to manage pain at night), and how different social networks shape service use.Future workA whole-systems approach considering integration across a wider network of partners is key to understanding the complex relationships between demand for and access to urgent care.Study registrationThis study is registered as UKCRN 32207.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Understanding young adults’ reasons for seeking ‘clinically unnecessary’ urgent and emergency care: A qualitative interview study

“…Additionally, those aged 18‐44 were more likely to feel overwhelmed when they had an unexpected health problem 24 . These data echo Turnbull et al's findings that young adults more frequently identified themselves as anxious and prone to worrying about their health and linked this to their use of urgent and emergency services 22 . This anxiety and lack of confidence may be an age effect: young adults may be facing unfamiliar symptoms for the first time and be less confident in making independent decisions about their seriousness, and have less familiarity with services.…”

“…Media portrayals often depict young adults as being used to a 24/7 culture and expecting services to be immediately available, or using EDs due to their chaotic lifestyles 19,20 . In research, a recent study exploring use of a range of urgent care services (111, ED, minor injuries unit, urgent care centre) found young adults identified the lack of alternatives as their reason for using EDs 21,22 . This could be driven by lack of access to GP services, 20,23 lack of knowledge of alternatives or confusion about how to use them 21,22 .…”

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“…On the demand side, public health campaigns admonish patients via marketing campaigns with blunt messages such as Don’t go to A&E . However, in a chronically under-resourced system, making relatively minor adjustments will yield relatively small results [ 13 ], and applying a broad approach to dissuading use of medical resources may have unintended negative consequences; most people cannot adequately distinguish between problems that are urgent , emergency , and routine care [ 15 ]. While there is much excitement about the potential for video consultations and the UK National Health Service (NHS) GP contract even states “every patient will have the right to online and video consultation by April 2021,” the accumulated experience has been that health IT solutions within the NHS tend to suffer “non adoption, abandonment, and challenges to scale-up, spread, and sustainability” [ 16 , 17 ].…”

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