Understanding patient preferences for emergency care for lower triage acuity presentations during GP hours: a qualitative study in Australia

Abstract

Background Low acuity presentations to Australian emergency departments drive long wait times, higher costs and may be better treated in primary care settings. This study sought to understand factors leading these patients to present to emergency departments. Methods Semi-structured interviews were carried out with patients at two tertiary emergency departments in Sydney during general practitioner opening hours. Nvivo was used to code the interviews and a thematic analysis was carried out to capture the main themes from the interviews. Results Forty-four interviews were included in the analysis across the two sites. They represented a diverse population in terms of ethnicity, education and socioeconomic background. Patient preferences for emergency care were organised into four main themes: (i) patients were referred (either by another health service, work, friend, or family), (ii) emergency department factors (convenience of investigations and severity of symptoms requiring emergency care), (iii) GP factors (does not have a GP, cannot find an appointment with a GP or has previously had a negative experience with a GP) and (iv) personal factors such as their connection to the hospital. Conclusion Multiple factors led patients to seek ED care for low acuity presentations during GP hours. Some of these factors could be addressed to meet patient needs in the community, however this is currently not the case. Addressing these factors to improve access to GP clinics and the availability of services outside the hospital setting could reduce ED presentations and likely improve patient experience.

Emergency department overcrowding: causes and solutions

“…Other studies conducted in Turkey have reported that the quality of ED care and ability to receive quick care affect patients’ decisions to use the ED for nonurgent care, which leads to higher costs and increases the workload of ED staff. [14,20] The results of this study also concur with those of Korczak et al, [21] who found that convenience of the ED and access to all tests and investigations in the ED contribute to ED attendance.…”

“I do not know the advantages of having a general practitioner” - a qualitative study exploring the views of low-acuity emergency patients without a regular general practitioner toward primary care

“…In turn, the main reason for not having a GP identified by this study was that patients move around or do not understand the health care system and the most appropriate care paths. The authors suggested that there should be services to enable patients to find a GP who meets their individual needs, arguing that this would increase GP attachment and continuity of care in the long term [ 34 ]. A targeted GP attachment program, as piloted in the interventional module of EMAPREPARE, could help to connect patients with GPs [ 20 ].…”