The Many Faces of Access: Reasons for Medically Nonurgent Emergency Department Visits

Abstract

Investigating why people use the hospital emergency department (ED) for visits considered medically nonurgent can enhance our understanding of people's expectations of health care services, of their conceptions of prudent lay judgment, and of difficulties in negotiating the logistics of primary care services. This study identified reasons for such ED use from users' perspectives in both pediatric and adult visits. Respondents were asked to explain what brought them to the ED and to define an emergency. The study was conducted in two northeastern U.S. hospital EDs. The analysis drew on a convenience sample of 408 (331 pediatric, 77 adult users) face-to-face interviews that employed both open- and closed-ended questions. Findings indicate most patients had medical insurance and a regular place of care and most arrived by car or taxi. Twelve main themes emerged under three main categories: conceptions of needs, appropriateness, and preference for the ED. The findings indicate that various reasons for ED use may be construed as access issues. These include beliefs regarding limited availability of after-hour consultation services and of timely appointments at one's primary care site. Drawing on the findings, a typology that distinguishes between groups of users according to their preference for the ED, a level of congruence between their own reason and their definition of an emergency was developed. The typology suggests that people's concerns that influence their decision to come to the ED cannot be solved simply by expanding primary care services or by educational interventions. Its application yields recommendations for services and interventions.

Does the Extension of Primary Care Practice Opening Hours Reduce the Use of Emergency Services?

“…Moll van Charante et al (2008) report that shorter waiting times and greater proximity are among the principal reasons for attending the ED and these findings are in line with Puig-Junoy et al (1998) who show that substitution patterns between ED and GP visits are particularly intense in response to lengthy waiting times to see local GPs. From a different perspective, Carlsen et al Guttman et al (2003) and McCusker et al (2010). However, so far very few studies have addressed the Italian case.…”

Why non-urgent patients choose emergency over primary care services? Empirical evidence and managerial implications

“…The first group is connected to the perception of a need to receive immediate care. Apart from some of the investigations [20,21], this emerges as one of the most important reasons found in the Italian studies [1,22,23], and also generally in Europe [18,24,25] and North America [11,19,[26][27][28][29][30][31][32][33]. A recent qualitative investigation [18] considers the perception of such need as a key factor leading to choose whether to use the A&ED and connects it to whether a self-diagnosis was carried out, i.e.…”

What Accounts For Differences In The Use Of Hospital Emergency Departments Across U.S. Communities?

“…7 Thus, EDs might have become more attractive sources of nonurgent care because of their convenience, round-the-clock care delivery, and open access without an appointment. 8 n Need for systematic analysis. Policymakers and health system planners would benefit from a systematic analysis of how ED use is interrelated with other developments in the health care system and differences in population characteristics.…”