“I'm Just a Patient”: Fear and Uncertainty as Drivers of Emergency Department Use in Patients With Chronic Disease

Rising, Kristin L; Hudgins, Anastasia; Reigle, M.A.; Hollander, Judd E.; Carr, Brendan G.

doi:10.1016/j.annemergmed.2016.03.053

Cited by 63 publications

(49 citation statements)

References 13 publications

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“…Interestingly, this finding is supported by evidence from international studies, where patients revealed fear and uncertainty as the main trigger to visit the ED. [15][16][17] In addition, authors of international studies have shown that economically and socially deprived patients are more likely to visit ED for acute and low-acuity reasons. A lack of adequate information about their health status and limited health literacy may contribute to uncertainty and health anxiety.…”

Section: Discussionmentioning

confidence: 99%

Patient motives behind low-acuity visits to the emergency department in Germany: a qualitative study comparing urban and rural sites

et al. 2016

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ObjectivesThe increasing number of low-acuity visits to emergency departments (ED) is an important issue in Germany, despite the fact that all costs of inpatient and outpatient treatment are covered by mandatory health insurance. We aimed to explore the motives of patients categorised with low-acuity conditions for visiting an ED.MethodsWe conducted a qualitative study in two urban and one rural ED. We recruited a purposive sample of adults, who were assigned to the lowest two categories in the Manchester triage system. One-to-one interviews took place in the ED during patients' waiting time for treatment. Interview transcripts were analysed using the qualitative data management software MAXQDA. A qualitative content analysis approach was taken to identify motives and to compare the rural with the urban sites.ResultsA total of 86 patients were asked to participate; of these, n=15 declined participation and n=7 were excluded because they were admitted as inpatients, leaving a final sample of 40 female and 24 male patients. We identified three pathways leading to an ED visit: (1) without primary care contact, (2) after unsuccessful attempts to see a resident specialist or general practitioner (GP) and (3) recommendation to visit the ED by an outpatient provider. The two essential motives were (1) convenience and (2) health anxiety, triggered by time constraints and focused usage of multidisciplinary medical care in a highly equipped setting. All participants from the rural region were connected to a GP, whom they saw more or less regularly, while more interviewees from the urban site did not have a permanent GP. Still, motives to visit the ED were in general the same.ConclusionsWe conclude that the ED plays a pivotal role in ambulatory acute care which needs to be recognised for adequate resource allocation.Trial registration numberDRK S00006053

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Section: Discussionmentioning

confidence: 99%

Patient motives behind low-acuity visits to the emergency department in Germany: a qualitative study comparing urban and rural sites

et al. 2016

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“…Several factors limit the generalisability of the study. PERSPEX enrolled 430 patients across two hospitals in Western Australia and is the largest of its kind . However, the results reflect a tiny proportion of the annual census and may not be applicable to other jurisdictions, including rural areas.…”

Section: Discussionmentioning

confidence: 99%

“…1 There is increasing involvement of laypeople in research planning in many disease-specific areas. [2][3][4][5] Data concerning patient priorities for emergency medicine (EM) research are lacking, 6,7 but prioritisation of future research directions within EM should be guided in part by patients. Potential benefits include improved patient awareness of, and satisfaction with, clinical research.…”

Section: Introductionmentioning

confidence: 99%

Patient perspectives on priorities for emergency medicine research: The PERSPEX study

McLay

McCutcheon

Arendts

et al. 2017

Emerg Medicine Australasia

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“…Research shows that one of their priorities is alleviation of fear and reassurance, which all too often involves some form of diagnostic testing. 14,15 Campaigns (e.g., Choosing Wisely 16 ) have identified a number of low value tests to avoid but they do not address the collateral impact of such testing on patient fear. Excessive use of diagnostic testing cannot be effectively addressed until we understand each patient’s motivation for seeking care and develop systems to alleviate their concerns in the absence of diagnostic testing.…”

Section: Introductionmentioning

confidence: 99%

The 2016 Academic Emergency Medicine Consensus Conference, “Shared Decision Making in the Emergency Department: Development of a Policy‐relevant Patient‐centered Research Agenda” Diagnostic Testing Breakout Session Report

Barrett

Rising

Bellolio

et al. 2016

Academic Emergency Medicine

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Diagnostic testing is an integral component of patient evaluation in the emergency department (ED). Emergency clinicians frequently use diagnostic testing to more confidently exclude “worst case” diagnoses rather than to determine the most likely etiology for a presenting complaint. Increased utilization of diagnostic testing has not been associated with reductions in disease-related mortality but has led to increased overall healthcare costs and other unintended consequences (e.g., incidental findings requiring further work-up, unnecessary exposure to ionizing radiation or potentially nephrotoxic contrast). Shared decision making (SDM) presents an opportunity for clinicians to discuss the benefits and harms associated with diagnostic testing with patients to more closely tailor testing to patient risk. This article introduces the challenges and opportunities associated with incorporating SDM into emergency care by summarizing the conclusions of the diagnostic testing group at the 2016 Academic Emergency Medicine Consensus Conference on SDM. Three primary domains emerged: 1) characteristics of a condition or test appropriate for SDM; 2) critical elements of and potential barriers to SDM discussions on diagnostic testing; and 3) financial aspects of SDM applied to diagnostic testing. The most critical research questions to improve engagement of patients in their acute care diagnostic decisions were determined by consensus.

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“I'm Just a Patient”: Fear and Uncertainty as Drivers of Emergency Department Use in Patients With Chronic Disease

Cited by 63 publications

References 13 publications

Patient motives behind low-acuity visits to the emergency department in Germany: a qualitative study comparing urban and rural sites

Patient motives behind low-acuity visits to the emergency department in Germany: a qualitative study comparing urban and rural sites

Patient perspectives on priorities for emergency medicine research: The PERSPEX study

The 2016 Academic Emergency Medicine Consensus Conference, “Shared Decision Making in the Emergency Department: Development of a Policy‐relevant Patient‐centered Research Agenda” Diagnostic Testing Breakout Session Report

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