“No Other Choice”: Reasons for Emergency Department Utilization Among Urban Adults With Acute Asthma

Abstract

Objectives: Asthma is considered "ambulatory care-sensitive," yet emergency department (ED) visits remain common. Few studies have examined how ED asthma patients choose their sites of urgent care. The authors explored reasons for asthma-related ED use among adults.Methods: From May to September 2012, semistructured qualitative interviews were conducted with a convenience sample of patients visiting a high-volume urban ED for asthma. A piloted interview guide was used; it had open-ended questions derived from clinical experience and a focus group of asthmatic adults who frequently use the ED for care. Interviews were conducted until theme saturation was reached. Interview transcripts and field notes were entered into NVivo 10 and double-coded, using an iterative process to identify patterns of responses, ensure reliability, examine discrepancies, and achieve consensus through content analysis.

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

“…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.…”

Comparing Statewide and Single‐center Data to Predict High‐frequency Emergency Department Utilization Among Patients With Asthma Exacerbation

“…Compared to the pediatric models, the adult models were more influenced by age, income, and primary insurance, potentially describing cost pressures in adults that are reduced in children. Qualitative interviews suggest that adult patients with asthma choose the ED for a number of reasons that are related to income—including concerns about insurance status, lack of medication and inability to access outpatient providers . The absence of an association with age in the pediatric models differs from prior reports.…”

“…In that study, the savings were greater than the costs of the program . For patients with asthma, reported reasons for ED use include lack of asthma medications and inability to access outpatient providers because of time availability, referral of severe cases to the ED or insurance status, as well as perceptions of appropriate locations of care based on symptom severity . Interventions to address high‐frequency utilization will need to consider the issues of access and availability, as well as unmet educational needs.…”

ED Care: Available, Competent, Affordable

“…The findings from the RAND report are borne out nicely by the qualitative work done by Lawson et al 6 In analyzing the content of semistructured interviews conducted with adult asthma patients in the ED at the Uni- versity of Pennsylvania, the authors identified the following themes as predisposing patients to use the ED: the ED is a fast or convenient site of care, the ED has appropriate resources and expertise, the patient was unable to access the PCP or necessary medication, treatment initiated at home was insufficiently effective, the symptoms were too severe to visit the usual provider, the patient was referred to the ED by the PCP or a friend or family member, or insurance would not cover an outpatient visit. Implicit in the concept of an ambulatory care-sensitive condition is the notion that the ED visit represents a failure-a failure of primary care, a failure of lack of primary care, a failure of patient education, or a failure of health literacy.…”

“…The patients interviewed by Lawson et al 6 in an article in this issue of Academic Emergency Medicine certainly understand the critical role played by the ED as a complement to their care. Why not focus instead on the ability of care providers to improve patient-centered outcomes, such as quality of life, days missed from work, or hospitalizations?…”