Health care utilization following a non-urgent visit in emergency department and primary care

Abstract

Unscheduled visits to an emergency department (ED) or to primary care (PC) are often followed by further healthcare contacts. Present knowledge about predisposing factors and differences between healthcare levels is sparse. The objectives of this study were to describe and to analyze factors influencing subsequent healthcare contacts within 30 days following a non-urgent ED visit or an unscheduled visit in PC. In this prospective cohort study, subjects were identified and interviewed at the time of a non-urgent ED visit or unscheduled visits to PC. Data of all healthcare contacts during 1 month were collected. The probability of reattendance was analyzed regarding socio-demographic factors, previous and present health care utilization, the physicians' perceptions of the urgency of the visit, and appropriateness of its level of care. More than half of the patients in both settings had at least one contact with healthcare the following month. In 16% of the ED patients and 9% of PC patients, these contacts were to an ED. In the multivariate analysis, patients with regular monitoring of chronic disease were associated with an increased probability of having one or more physician visit the following month (OR 1.97 CI 95% 1.15-3.36). In conclusion, previous health care utilization was associated with an increased probability of one or more further physician visits the following month, regardless of the setting for the index visit or other patients characteristics. Physicians' perception of urgency did not influence the probability of further contacts.

GP cooperative and emergency department: an exploration of patient flows

“…On the other hand, many ED contacts (69%) had a follow‐up contact with an outpatient clinic, while other research has reported figures varying from 26% to 49% [1,3,16]. Also, non‐urgent self‐referring patients who received an X‐ray frequently had a follow‐up contact.…”

“…At the GPC, most contacts were completed directly, as only 37% of non‐urgent patients had a follow‐up contact. Previous studies found that one‐third to half of patients had a follow‐up contact after a GPC or a nurse telephone contact [11,12,16,17]. Several reasons for a follow‐up contact have been identified, such as worsening of complaints, need for reassurance or dissatisfaction [12,18,19].…”

Inappropriate use of the emergency department for nonurgent conditions: Patient characteristics and associated factors at a Japanese hospital

“…Our study results did not confirm a relationship between anxiety and/or depression and inappropriate out‐of‐hours ED use. The relationship between anxiety and depression and use of emergency medical care has been investigated in previous studies in other countries . This may be due to factors such as the need for appointments and other limitations in those countries making it easier for patients with anxiety and/or depression to seek a quick consultation in the ED, whereas in Japan the system of free access allows patients to easily seek daytime consultations.…”

“…The relationship between anxiety and depression and use of emergency medical care has been investigated in previous studies in other countries. 4,22 This may be due to factors such as the need for appointments and other limitations in those countries making it easier for patients with anxiety and/or depression to seek a quick consultation in the ED, whereas in Japan the system of free access allows patients to easily seek daytime consultations. The inappropriate use group may perceive differences between care during regular consultation hours and out-of-hours emergency care.…”

Long‐Term Prediction of Emergency Department Revenue and Visitor Volume Using Autoregressive Integrated Moving Average Model

“…Overcrowding in emergency departments (EDs) reflects dysfunction in healthcare systems [1]. Contributing factors including mismatch between ED capacity and various input, throughput, and output factors as well as insufficient capacity [2]. During the 12-year period from 1995 to 2006, annual ED visits in Taiwan increased 40%, from 4,664,209 to 6,569,247 per year [3].…”