Patients presenting to the emergency department: the use of other health care services and reasons for presentation

Abstract

Objective: Some low-acuity emergency department (ED) presentations are considered convenience visits and potentially avoidable with improved access to primary care services. This study assessed the frequency and determinants of patients' efforts to access alternative care before ED presentation. Methods: Patients aged 17 years and older were randomly selected from 2 urban ED sites in Edmonton. Survey data were collected on use and characteristics of alternative care before the ED visit. Information was also collected on patient demographics and factors influencing their perception of whether the ED was the best care option. Results: Of the 1389 patients approached, 905 (65%) completed the survey and data from 894 participants were analyzed. Sixty-one percent reported that they sought alternative care before visiting the ED. Eighty-nine of the patients who attempted alternative access before the ED visit felt that the ED was their best care option. Results of the multivariate logistic regression analysis showed that injury presentation, living arrangements, smoking status and whether or not patients had a family practitioner were predictors for seeking alternative care before visiting the ED. Conclusion: Most ambulatory patients attempt to look for other sources of care before presenting to the ED. Despite this attempted access to alternative care, while patients wait for ED care, they perceive that the ED is their best care option at that point in time.

Impact of comorbidity and healthcare utilization on colorectal cancer stage at diagnosis: literature review

“…These individuals may have been unable to access other health services (i.e., screening or primary care) earlier in their disease trajectory. Han et al [27] surveyed ER visitors and found that one-fifth of visitors had no primary care physician, and that many had tried to access alternative sources of care prior to visiting the ER. Thus, for some, the ER may be seen as the only option, or last resort, for medical care.…”

“…As indicated in the literature [25,26], we expected increased regional physician supply to improve access to care and subsequently allow increased contact with the healthcare system. In relation, it has been demonstrated that ER services are used by individuals who have difficulty accessing other sources of care, many of whom do not have a primary care physician [27].…”

Emergency department overcrowding and access block

“…12 Moreover, patients of lower acuity and urgency do not occupy acute care stretchers, require little nursing care, and typically have brief treatment times. The myth of ''inappropriate use'' should be permanently dispelled, and administrators and politicians should be encouraged to avoid attributing EDOC to ambulatory patient ED health services access.…”

Predictors of Low-Acuity Emergency Department Use by Patients Enrolled in a Family Health Team

“…Much discussion in the literature has focused on trying to identify patients with low-acuity presenting complaints to see if they might be safely diverted away from the ED. [11][12][13][14] A recent study demonstrated limited concordance between presenting complaints and ED discharge diagnoses, suggesting that presenting complaints are unable to accurately identify non-emergent ED use. 11 The study found that only 6.3% of patients presenting to the ED had primary care-treatable diagnoses based on discharge diagnosis and an algorithm.…”