Factors associated with non-urgent utilization of Accident and Emergency services: a case-control study in Hong Kong

Lee, Albert; Lau, FL; Hazlett, Clarke B.; Kam, Chak‐Wah; Wong, P.M.; Wong, Tai Wai; Chow, Susan Ka Yee

doi:10.1016/s0277-9536(00)00039-3

Cited by 72 publications

(101 citation statements)

References 25 publications

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“…The majority of the studies that investigated proximity to the ED did not show a significant association with inappropriate use 14,16,32,37 . However, according to Oktay et al 21 , proximity to the ED was the principal reason for inappropriate complaints.…”

Section: 2%mentioning

confidence: 94%

“…Of the 11 articles that reported prevalence rates for inappropriate ED use greater than or equal to 45%, seven 6,15,27,28,29,30,31,32 used more rigorous criteria to define appropriate ED use, such as requiring observation for more than 12 hours or hospitalization; three other 33,34,35 used samples that excluded populations presenting greater severity. Meanwhile, among seven studies 6,36,37,38,39,40,41 that found prevalence rates lower than 20%, three used self-perceived urgency as the definition of appropriate ED use 6,37,38 ; two others used more rigorous criteria to define inappropriate use 36,41 ; and the study by Finn et al 40 evaluated a lower-risk population for inappropriate use (65 years or older) ( Table 1).…”

Section: Prevalencementioning

confidence: 99%

“…• Appropriate: resulted in hospitalization, death, was transferred to another hospital, or explicit criteria based on diagnostic tests or specific treatments (modified, excluding chest X-ray) 21 Bianco et al 37 Asia Shah et al 31 Lee et al 32 Others Rodríguez et al 23 Dent et al 27 Finn et al 40 Stein et al 26 Based Classified in 3 levels: emergency, urgent, and non-urgent.…”

Section: Ctasmentioning

confidence: 99%

“…Sixteen studies showed an inverse association between age and inappropriate ED use 12,13,14,16,19,21,22,23,25,30,31,32,33,34,37,42 . Only two studies 40,43 failed to show this association.…”

Section: Demographic Variablesmentioning

confidence: 99%

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Inappropriate use of emergency services: a systematic review of prevalence and associated factors

2009

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This systematic review aimed to measure the prevalence of inappropriate emergency department (ED) use by adults and associated factors. The review included 31 articles published in the last 12 years. Prevalence of inappropriate ED use varied from 20 to 40% and was associated with age and income. Female patients, those without co-morbidities, without a regular physician, without a regular source of care, and those not referred to the ED by a physician also showed more inappropriate ED use, with the relative risk varying from 1.12 to 2.42. Difficulties in accessing primary health care (difficulties in setting appointments, longer waiting periods, and short business hours at the primary health care service) were also associated with inappropriate ED use. Thus, primary care requires fully qualified patient reception and efficient triage to promptly attend cases that cannot wait. It is also necessary to orient the population on situations in which they should go to the ED and on the disadvantages of consulting the ED when the case is not really urgent.

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Section: 2%mentioning

confidence: 94%

Section: Prevalencementioning

confidence: 99%

Section: Ctasmentioning

confidence: 99%

Section: Demographic Variablesmentioning

confidence: 99%

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Inappropriate use of emergency services: a systematic review of prevalence and associated factors

2009

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“…The definition has been heavily debated in the United States (US), as some medical insurance claims are only reimbursed if they are considered to be resulting from 'an emergency medical condition', 1 and recent publications in the Australian context have debated 'inappropriate' emergency health service users, which refer to 'non-emergency cases'. [2][3][4][5][6] The definition and classification of a 'health emergency' therefore requires investigation. There is a body of published work on 'inappropriate' or non-emergency attendees at hospital emergency departments (EDs); however, the definition of what is a health emergency and what is an inappropriate attendance is contested.…”

Section: Introductionmentioning

confidence: 99%

What is a health emergency? The difference in definition and understanding between patients and health professionals

Morgans

Burgess

2011

Aust. Health Review

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Background. Investigations into 'inappropriate' use of emergency health services are limited by the lack of definition of what constitutes a health emergency. Position papers from Australian and international sources emphasise the patient's right to access emergency healthcare, and the responsibility of emergency health care workers to provide treatment to all patients. However, discordance between the two perspectives remain, with literature labelling patient use of emergency health services as 'inappropriate'.Objective. To define a 'health emergency' and compare patient and health professionals perspectives. Method. A sample of 600 emergency department (ED) patients were surveyed about a recent health experience and asked to rate their perceived urgency. This rating was compared to their triage score allocated at the hospital ED.Results. No significant relationship was found between the two ratings of urgency (P = 0.51).Conclusions. Differing definitions of a 'health emergency' may explain patient help-seeking behaviour when accessing emergency health resources including hospital ED and ambulance services. A new definition of health emergency that encapsulates the health professional and patient perspectives is proposed. An agreed definition of when emergency health resources should be used has the potential to improve emergency health services demand and patient flow issues, and optimise emergency health resource allocation.What is known about the topic? Although many patients' access emergency healthcare services in an emergency, many patients' access emergency healthcare services when their condition is non-urgent, and avoid using emergency health care when their condition requires. What does this paper add? This paper identifies that health professionals and patients have different perspectives on what constitutes an emergency and when emergency health resources should be used.This paper also provides a review of literature and triage policy papers that identify key differences in the assessment of a health event, and shows that health professionals base their assessment on knowledge and physiological measures, whereas patients used socio-emotional cues to identify medical urgency. What are the implications for practitioners? Practitioners cannot expect their patients to be able to accurately evaluate the urgency of a health event. An emergency is difficult to define as health conditions are dynamic, and may change in urgency over time, and relative urgency is a continuous variable, rather than a dichotomous 'health emergency' v. 'not a health emergency'.

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Emergency Department Use Across Income Groups Following an Increase in Cost-Sharing

Wu,

Wang,

Zhao

et al. 2023

JAMA Netw Open

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ImportanceTo encourage the appropriate utilization of emergency care, cost-sharing for emergency care was increased from HK$100 (US $12.8) to HK$180 (US $23.1) per visit in June 2017 in all public hospitals in Hong Kong. However, there are concerns that this increase could deter appropriate emergency department (ED) visits and be associated with income-related disparities.ObjectiveTo examine changes in ED visits after the fee increase.Design, Setting, and ParticipantsThis retrospective cohort study used administrative data from June 2015 to May 2019 from all public hospitals in Hong Kong. Participants included all Hong Kong residents aged 64 years and younger, categorized into low-income, middle-income, and high-income groups according to the median household income in their district of residence. Data analysis was performed from May to June 2023.Main Outcomes and MeasuresThe primary outcome was the ED visit rate per 100 000 people per month, categorized into 3 severity levels (emergency, urgent, and nonurgent). Secondary outcomes include general outpatient (GOP) visit rate, emergency admission rate, and in-hospital mortality rate per month at public hospitals. Segmented regression analyses were used to estimate changes in the level and slope of outcome variables before and after the fee increase.ResultsThis study included a total of 5 441 679 ED patients (2 606 332 male patients [47.9%]; 2 108 933 patients [38.5%] aged 45-64 years), with 2 930 662 patients (1 407 885 male patients [48.0%]; 1 111 804 patients [37.9%] aged 45-64 years) from the period before the fee increase. The fee increase was associated with an 8.0% (95% CI, 7.1%-9.0%) immediate reduction in ED visits after June 2017, including a 5.9% (95% CI, 3.3%-8.5%) reduction in urgent visits and an 8.9% (95% CI, 8.0%-9.8%) reduction in nonurgent visits. In addition, a 5.7% (95% CI, 4.7%-6.8%) reduction of emergency admissions was found, whereas no significant changes were observed in in-hospital mortality. Specifically, a statistically significant increase in GOP visits (4.1%; 95% CI, 0.9%-7.2%) was found within the low-income group, but this association became insignificant after controlling for the social security group, who were exempted from payment, as a control.Conclusions and RelevanceIn this cohort study, the fee increase was not associated with changes in ED visits for emergency conditions, but there was a negative and significant association with both urgent and nonurgent conditions across all income groups. Considering the marginal increase in public GOP services, further study is warranted to examine strategies to protect low-income people from avoiding necessary care.

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Factors associated with non-urgent utilization of Accident and Emergency services: a case-control study in Hong Kong

Cited by 72 publications

References 25 publications

Inappropriate use of emergency services: a systematic review of prevalence and associated factors

Inappropriate use of emergency services: a systematic review of prevalence and associated factors

What is a health emergency? The difference in definition and understanding between patients and health professionals

Emergency Department Use Across Income Groups Following an Increase in Cost-Sharing

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