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

Abstract

Background Studies have identified young adults as more likely to use emergency departments for ‘clinically unnecessary’ problems, with limited similar evidence for emergency ambulance use. Media portrayals depict young adults as motivated by ‘convenience’, but little research has explored the reasons for their help‐seeking behaviour. Methods Qualitative interviews with 16 young adults (18‐30) considered by clinicians to have made unnecessary use of emergency ambulance, emergency department or an urgent GP appointment. Data analysis was informed by interpretive phenomenological analysis. Findings A number of interrelated factors contributed to participants’ decisions. They were anxious about the seriousness of their symptoms, sometimes exacerbated by reduced coping capacity due to poor mental health or life stresses. They looked to others to facilitate their decision making, who sometimes encouraged urgent contact. They wanted to avoid impact on existing day‐to‐day commitments including work or study. They had strong views about different health services, sometimes based on frustration with lack of resolution of on‐going health problems. Convenience was not identified as a significant factor, although some actions could be interpreted in this light if the context was not considered. Conclusions Young adults make ‘clinically unnecessary’ use of urgent and emergency care for more than convenience. Their decisions need to be understood in relation to the complexity of their experience, including lack of confidence in making health‐related decisions, lowered coping capacity and concern to maintain normal daily life.

Health Care Utilization among Young Adults in Primary and Emergency Health Care : The Need for Support, the Capacity to Support, and the Communication in between

“…The need for speed, or as mentioned by health care personnel, "seeking a 'quick fix'" (study III), could be considered more of a need to function normally as quick as possible to attend to responsibilities rather than having to do with convenience. As argued in earlier research, exploring the complexity behind the 'convenience' label is important for understanding young adults' decision-making (55). Findings from study III demonstrate several perceptions of young adults that can be placed under the convenience label, whereas study IV demonstrated several factors that make it difficult to feel comfortable handling symptoms by yourself.…”

“…Another country having a similar health care structure as Sweden that has issued health care utilization from the perspective of young adults is the United Kingdom (44,54,55). In one study, five aspects were recognized as being important for young adults when visiting primary care: accessibility and availability, confidentiality of health-related information, continuity of care, communication during the encounter, and behaviours and attitudes (44).…”

“…When looking closer at young adults' experiences visiting primary care, difficulties negotiating the primary care system, trust issues, and communication difficulties emerged (54). In addition, when interviewing young adults considered by health care personnel to have made unnecessary use of emergent care, both at EDs and PHCs, six themes arise as drivers for seeking care: 1) Concern about seriousness of symptoms and desire for reassurance, 2) Reduced coping capacity due to poor mental health, stress, lack of resources, 3) Influence of others, particularly social networks, 4) Concern about impact of symptoms on daily life, 5) Positive and negative views of different services, and 6) Frustration at lack of resolution of an ongoing problem, despite previous efforts (55).…”

An integrative review of adult patient-reported reasons for non-urgent use of the emergency department

“…There was a self-perceived sense of severity or urgency to their medical matters, despite that their presenting complaints were deemed non-urgent [ 16 – 54 , 85 – 90 ]. Many patients described having feelings of anxiety, uncertainty or significant concern about their health problem [ 22 , 45 , 65 , 70 , 88 , 92 – 95 ]. Often patients had experienced pain or other discomforts which impacted their function and they desired immediate relief [ 22 , 42 , 45 , 70 – 73 , 88 , 93 , 94 , 96 , 97 ].…”

“…Many patients described having feelings of anxiety, uncertainty or significant concern about their health problem [ 22 , 45 , 65 , 70 , 88 , 92 – 95 ]. Often patients had experienced pain or other discomforts which impacted their function and they desired immediate relief [ 22 , 42 , 45 , 70 – 73 , 88 , 93 , 94 , 96 , 97 ]. In some cases, they had attempted self-treatment at home, without good effect [ 73 , 86 , 96 , 98 ], or had sought out primary care without resolve [ 21 , 42 , 53 , 66 , 74 , 75 , 88 , 92 ].…”