Emergency care seeking behaviour : in relation to patients' and providers' perceptions and attitudes

Abstract

Background: This study was developed with the main objective of evaluating users of emergency departments (ED) triaged as non-urgent following a period of time when large cutbacks in hospital and ambulatory care were taking place in Sweden.

Aim: To analyse patients seeking medical attention for conditions triaged as non-urgent at an ED and patients who used non-scheduled services in primary care (PC) in relation to their symptoms, perceptions and the physicians’ assessments of urgency, and to register their subsequent health care use within one month. The question was; are non-urgent patients at the ED similar to unscheduled PC patients?

Methods: In this cross-sectional study subjects from a defined catchment area were identified and interviewed at the time of a non-scheduled PC visit, or a non-referred, non-urgent (triage level 4) ED visit. Structured face-to-face interviews and a concomitant questionnaire to the treating physician were used to collect the data in office hours during a nine-week period. The subjects’ subsequent health care contacts within a month were registered through a population based registry.

Results: Of 924 eligible patients, 736 (80%) agreed to participate, 194 at the ED and 542 at the nine PC centres. The two groups shared demographic characteristics except for gender. A majority (47%) of the patients at the PC centres had respiratory symptoms, whereas most non-urgent ED patients (52%) had digestive symptoms, musculoskeletal symptoms, or symptoms due to trauma. Both groups had used health care frequently, but ED patients had previously been more often hospitalized (35%) than PC patients (21%) (p<0.001). ED patients were more anxious about and disturbed by their symptoms and had had a shorter duration of symptoms. Regular monitoring of chronic disease was associated with an increased probability of another physician visit the following month (OR 2.0; CI 95%, 1.2-3.4). The majority of patients was found to have complaints appropriate for the setting, but general practitioners considered to a higher extent than their ED colleagues that patients had chosen an appropriate level of care (p<0.001). General practitioners were older and had longer clinical experience than physicians at the ED. ED patients, having chosen an appropriate care level as judged by the physician, were distinguished by different symptom presentation, shorter duration of symptoms, and more regular previous health care use. Men without previous regular health care use were more likely to present symptoms assessed as inappropriate for the ED (p <0.001), and this group was also less likely to use health information or advice before seeking care (p<0.01).

Conclusions: Non-urgent ED patients and PC patients had similar socio-demographic characteristics but differed regarding types of diseases, previous hospitalizations and current perception of symptoms. Patients with disorders that ED physicians considered inappropriate for the setting had low previous regular health care use but their treating physicians were less experienced than the physicians in PC. General practitioners agreed with their patients´ choice of health care level to a large extent. Information concerning appropriate health care level could be targeted to individuals with low previous health care use. No evidence was found for any widespread misuse of the ED service during the time of the study.