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Sinnott C, Ansari A, Price E, Fisher R, Beech J, Alderwick H, Dixon-Woods M. Understanding access to general practice through the lens of candidacy: a critical review of the literature. Br J Gen Pract 2024; 74:e683-e694. [PMID: 38936884 PMCID: PMC11441605 DOI: 10.3399/bjgp.2024.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/13/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Dominant conceptualisations of access to health care are limited, framed in terms of speed and supply. The Candidacy Framework offers a more comprehensive approach, identifying diverse influences on how access is accomplished. AIM To characterise how the Candidacy Framework can explain access to general practice - an increasingly fraught area of public debate and policy. DESIGN AND SETTING Qualitative review guided by the principles of critical interpretive synthesis. METHOD We conducted a literature review using an author-led approach, involving iterative analytically guided searches. Articles were eligible for inclusion if they related to the context of general practice, without geographical or time limitations. Key themes relating to access to general practice were extracted and synthesised using the Candidacy Framework. RESULTS A total of 229 articles were included in the final synthesis. The seven features identified in the original Candidacy Framework are highly salient to general practice. Using the lens of candidacy demonstrates that access to general practice is subject to multiple influences that are highly dynamic, contingent, and subject to constant negotiation. These influences are socioeconomically and institutionally patterned, creating risks to access for some groups. This analysis enables understanding of the barriers to access that may exist, even though general practice in the UK is free at the point of care, but also demonstrates that a Candidacy Framework specific to this setting is needed. CONCLUSION The Candidacy Framework has considerable value as a way of understanding access to general practice, offering new insights for policy and practice. The original framework would benefit from further customisation for the distinctive setting of general practice.
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Affiliation(s)
- Carol Sinnott
- Health Foundation professor of healthcare improvement studies, The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge
| | - Akbar Ansari
- Health Foundation professor of healthcare improvement studies, The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge
| | - Evleen Price
- Health Foundation professor of healthcare improvement studies, The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge
| | | | | | | | - Mary Dixon-Woods
- Health Foundation professor of healthcare improvement studies, The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge
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Kümpel L, Oslislo S, Resendiz Cantu R, Möckel M, Heintze C, Holzinger F. "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. BMC Health Serv Res 2024; 24:629. [PMID: 38750500 PMCID: PMC11097521 DOI: 10.1186/s12913-024-10977-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/10/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Emergency departments (ED) worldwide have to cope with rising patient numbers. Low-acuity consulters who could receive a more suitable treatment in primary care (PC) increase caseloads, and lack of PC attachment has been discussed as a determinant. This qualitative study explores factors that contribute to non-utilization of general practitioner (GP) care among patients with no current attachment to a GP. METHOD Qualitative semi-structured telephone interviews were conducted with 32 low-acuity ED consulters with no self-reported attachment to a GP. Participants were recruited from three EDs in the city center of Berlin, Germany. Data were analyzed by qualitative content analysis. RESULTS Interviewed patients reported heterogeneous factors contributing to their PC utilization behavior and underlying views and experiences. Participants most prominently voiced a rare need for medical services, a distinct mobility behavior, and a lack of knowledge about the role of a GP and health care options. Views about and experiences with GP care that contribute to non-utilization were predominantly related to little confidence in GP care, preference for directly consulting medical specialists, and negative experiences with GP care in the past. Contrasting their reported utilization behavior, many interviewees still recognized the advantages of GP care continuity. CONCLUSION Understanding reasons of low-acuity ED patients for GP non-utilization can play an important role in the design and implementation of patient-centered care interventions for PC integration. Increasing GP utilization, continuity of care and health literacy might have positive effects on patient decision-making in acute situations and in turn decrease ED burden. TRIAL REGISTRATION German Clinical Trials Register: DRKS00023480; date: 2020/11/27.
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Affiliation(s)
- Lisa Kümpel
- Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany.
| | - Sarah Oslislo
- Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany
| | - Rebecca Resendiz Cantu
- Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine, Campus Virchow Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Martin Möckel
- Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine, Campus Virchow Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Christoph Heintze
- Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany
| | - Felix Holzinger
- Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany
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Tuz C, Özçakir A. Why patients self-refer to the emergency service for nonurgency?: A mix-method survey from a family medicine perspective. Medicine (Baltimore) 2024; 103:e37453. [PMID: 38457545 PMCID: PMC10919528 DOI: 10.1097/md.0000000000037453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/08/2023] [Accepted: 02/09/2024] [Indexed: 03/10/2024] Open
Abstract
The definition of "nonurgent emergency service visits" is visits to conditions for medical conditions that require attention but are not life-threatening immediately or severe enough to require urgent intervention. This study aims to investigate the reasons why patients choose to self-refer to the emergency service (ES) instead of their primary care health center for nonurgent complaints. The study was carried out in a tertiary hospital. The survey consisted of 2 parts with sociodemographic questions, knowledge of their family physician, and the reason why it has been applied to the ES with multiple choice answers. Of the 325 patients, the mean age was 34.5 years and 54.2% were women. Also, 26 of the patients were reported as "urgent" by the doctor. The main reasons underlying self-referred patients were classified into 4 themes: "urgency" (13.8%), advantages of ES (12.9%); disadvantages of primary care (25.1%), and other (45.9%). The most common reason patients self-refer to the ES was their belief in "being urgent" (61%). In this study, 26.8%, (n = 84) of the patients are not happy with their family physicians, while only 13.2% (N = 43) prioritize the ES advantages.
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Affiliation(s)
- Canan Tuz
- Department of Family Medicine, Bursa Uludag University, Bursa, Turkey
| | - Alis Özçakir
- Department of Family Medicine, Bursa Uludag University, Bursa, Turkey
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Koh VTJ, Ong RHS, Chow WL, Tiah L, Oh HC, Yow WQ, Sharma S, Huat Yap JC. Understanding patients' health-seeking behaviour for non-emergency conditions: a qualitative study. Singapore Med J 2023:384043. [PMID: 37675670 DOI: 10.4103/singaporemedj.smj-2020-494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
| | | | - Wai Leng Chow
- Epidemiology and Disease Control, Ministry of Health, Singapore
| | - Ling Tiah
- Accident and Emergency Department, Changi General Hospital, Singapore
| | - Hong Choon Oh
- Health Services Research, Changi General Hospital, Singapore
| | - Wei Quin Yow
- Humanities Arts and Social Sciences, Singapore University of Technology and Design, Singapore
| | - Shrutivandana Sharma
- Engineering Systems and Design, Singapore University of Technology and Design, Singapore
| | - Jason Chin Huat Yap
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Landa P, Lalonde JD, Bergeron F, Kassim SA, Côté A, Gartner JB, Tanfani E, Resta M. Impact of primary health care reforms in Quebec Health Care System: a systematic literature review protocol. BMJ Open 2023; 13:e068666. [PMID: 37524547 PMCID: PMC10391782 DOI: 10.1136/bmjopen-2022-068666] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION During the last decade the Quebec Public Health Care System (QPHCS) had an important transformation in primary care planning activity. The increase of the service demand together with a significant reduction of supply in primary care may be at risk of reducing access to health care services, with a negative impact on costs and health outcomes. The aims of this systematic literature review are to map and aggregate existing literature and evidence on the primary care provided in Quebec, showing the benefits and limitations associated with the health policies developed in the last two decades, and highlighting areas of improvement. METHODS AND ANALYSIS PubMed, EMBASE, Web of Science and CINAHL will be searched for articles and government reports between January 2000 and January 2022 using a prespecified search strategy. This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Protocols and has been registered with PROSPERO. A wide range of electronic databases and grey literature sources will be systematically searched using predefined keywords. The review will include any study design, with the exclusion of protocols, with a focus on the analysis of health care policies, outcomes, costs and management of the primary health care services, published in either English or French languages. Two authors will independently screen titles, abstracts, full-text articles and select studies meeting the inclusion criteria. A customised data extraction form will be used to extract data from the included studies. Results will be presented in tabular format developed iteratively by the research team. ETHICS AND DISSEMINATION Research ethics approval is not required as exclusively secondary data will be used. Review findings will synthesise the characteristics and the impact of the reforms of QPHCS of the last two decades. Findings will therefore be disseminated in peer-reviewed journals, conference presentations and through discussions with stakeholders. PROSPERO REGISTRATION NUMBER CRD42023421145.
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Affiliation(s)
- Paolo Landa
- Département d'opérations et systèmes de décision, Universite Laval Faculté des sciences de l'administration, Quebec, Quebec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Quebec - Université Laval, Quebec, Quebec, Canada
| | - Jean-Denis Lalonde
- Département d'opérations et systèmes de décision, Universite Laval Faculté des sciences de l'administration, Quebec, Quebec, Canada
- Départment de Management, Universite Laval, Quebec, Quebec, Canada
| | - Frédéric Bergeron
- Bibliothèque-Direction des services-conseils, Université Laval, Quebec, Quebec, Canada
| | | | - André Côté
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Quebec - Université Laval, Quebec, Quebec, Canada
- Départment de Management, Universite Laval, Quebec, Quebec, Canada
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Quebec, Canada
| | - Jean-Baptiste Gartner
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Quebec - Université Laval, Quebec, Quebec, Canada
| | - Elena Tanfani
- Dipartimento di Economia, Università degli Studi di Genova, Genoa, Italy
| | - Marina Resta
- Dipartimento di Economia, Università degli Studi di Genova, Genoa, Italy
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Cariello C, Grazioli VS, Nikles J, Schmutz E, Hugli O, Bodenmann P. Understanding the experience in the healthcare system of non-migrant and migrant frequent users of the emergency department in French-speaking Switzerland: a comparative qualitative study. BMJ Open 2023; 13:e069272. [PMID: 37094894 PMCID: PMC10151913 DOI: 10.1136/bmjopen-2022-069272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 04/05/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Previous research revealed the vulnerability of frequent users of emergency department (FUED) because of concomitant medical, psychological and social issues. Case management (CM) provides FUED with effective medical and social support, however, the heterogeneity of this population has highlighted the need to explore the specific needs of FUED subpopulations. In response, this study aimed to explore qualitatively the lived experience of migrant and non-migrant FUED in the healthcare system to identify unmet needs. METHODS Adult migrant and non-migrant FUED (≥ 5 visits in the ED in the past 12 months) were recruited in a Swiss university hospital to collect qualitative data on their experience within the Swiss health system. Participants were selected based on predefined quotas for gender and age. Researchers conducted one-on-one semistructured interviews until reaching data saturation. Inductive conventional content analysis was used to analyse qualitative data. RESULTS In total, 23 semistructured interviews were conducted (11 migrant FUED and 12 non-migrant FUED). Four main themes emerged from the qualitative analysis: (1) self-evaluation of the Swiss healthcare system; (2) orientation within the healthcare system; (3) relationship with caregivers and (4) perception of own health. While both groups were overall satisfied with the healthcare system and care provided, migrant FUED reported language and financial barriers to access it. Both groups expressed overall satisfaction over their relationship with healthcare professionals, although migrant FUED reported a feeling of illegitimacy to consult the ED based on social status, whereas non-migrant FUED felt more often the need to justify their use of the ED. Finally, migrant FUED perceived their own health to be affected by their status. CONCLUSION This study highlighted difficulties specific to subpopulations of FUED. For migrant FUED, these included access to care and impact of migrant status on own health. Adapting CM to the specific needs of migrant FUED could help reduce their vulnerability.
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Affiliation(s)
- Carmen Cariello
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Justin Nikles
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Elodie Schmutz
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
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Kümpel L, Oslislo S, Resendiz Cantu R, Möckel M, Heintze C, Holzinger F. Exploring the views of low-acuity emergency department consulters on an educational intervention and general practitioner appointment service: a qualitative study in Berlin, Germany. BMJ Open 2023; 13:e070054. [PMID: 37085303 PMCID: PMC10124305 DOI: 10.1136/bmjopen-2022-070054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES Low-acuity patients presenting to emergency departments (EDs) frequently have unmet ambulatory care needs. This qualitative study explores the patients' views of an intervention aimed at education about care options and promoting primary care (PC) attachment. DESIGN Qualitative telephone interviews were conducted with a subsample of participants of an interventional pilot study, based on a semi-structured interview guide. The data were analysed through qualitative content analysis. SETTING The study was carried out in three EDs in the city centre of Berlin, Germany. PARTICIPANTS Thirty-two low-acuity ED consulters with no connection to a general practitioner (GP) who had participated in the pilot study were interviewed; (f/m: 15/17; mean age: 32.9 years). INTERVENTION In the pilot intervention, ED patients with low-acuity complaints were provided with an information leaflet on appropriate ED usage and alternative care paths and they were offered an optional GP appointment scheduling service. Qualitative interviews explored the views of a subsample of the participants on the intervention. RESULTS Interviewees perceived both parts of the intervention as valuable. Receiving a leaflet about appropriate ED use and alternatives to the ED was viewed as helpful, with participants expressing the desire for additional online information and a wider distribution of the content. The GP appointment service was positively assessed by the participants who had made use of this offer and seen as potentially helpful in establishing a long-term connection to GP care. The majority of patients declining a scheduled GP appointment expected no personal need for further medical care in the near future or preferred to choose a GP independently. CONCLUSIONS Low-acuity ED patients seem receptive to information on alternative acute care options and prevailingly appreciate measures to encourage and facilitate attachment to a GP. Promoting PC integration could contribute to a change in future usage behaviour. TRIAL REGISTRATION NUMBER DRKS00023480.
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Affiliation(s)
- Lisa Kümpel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, Berlin, Germany
| | - Sarah Oslislo
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, Berlin, Germany
| | - Rebecca Resendiz Cantu
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Augustenburger Platz 1, Berlin, Germany
| | - Martin Möckel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Augustenburger Platz 1, Berlin, Germany
| | - Christoph Heintze
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, Berlin, Germany
| | - Felix Holzinger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, Berlin, Germany
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Touhami D, Essig S, Debecker I, Scheel-Sailer A, Gemperli A. The effect of the general practitioner as the first point of contact for care on the satisfaction with health care services in persons living with chronic spinal cord injury: A cross-sectional study. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 177:48-56. [PMID: 36959067 DOI: 10.1016/j.zefq.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 10/15/2022] [Accepted: 12/11/2022] [Indexed: 03/25/2023]
Abstract
OBJECTIVE The primary objective of this study was to investigate the effect of having a general practitioner (GP) as a first point of contact for care on the satisfaction with care services in persons with spinal cord injury (SCI), and how this effect is related to socio-demographic and health-related factors. METHODS This is a cross-sectional survey conducted within the framework of the Swiss Spinal Cord Injury Cohort Study Community Survey 2017. Outcome measures comprised three aspects of care (treatment with respect, understandability of explanations, and involvement in decision-making) and satisfaction with GP care and SCI centres. Information was grouped by first contact of care (GP or SCI specialist) and compared using the Mann-Whitney U test and logistic regression analysis. RESULTS Out of 3,959 invitees, 1,294 participants (33%) completed the survey. No significant association was found between the three aspects of care and the first contact of care. Persons who first contacted a GP and lived within a 10-minute travel distance to the GP practice were significantly less likely to be satisfied with their GP care (-5.7 percentage points, CI 95% = -10.7, -0.7), as compared to those living farther away. Persons who first contacted a GP rather than an SCI specialist were more likely to be satisfied with their GP care if married (7.1 percentage points, CI 95% = 1.4, 12.7), employed (6.6 percentage points, CI 95% = 0.9, 12.3), had a high social status (11.0 percentage points, CI 95% = 2.0, 20.1), or had tetraplegia (10.8 percentage points, CI 95% = 3.6, 18.1). For the same group, satisfaction with SCI centres was significantly higher in persons with good (10.1 percentage points, CI 95% = 0.1, 20.1) or very good health (8.2 percentage points, CI 95% = 1.0, 15.4), as compared to those with poor health. CONCLUSION The majority of participants were satisfied with the services offered by their first contact point for care, with variations due to factors endogenous to the participants. Socio-demographic and health-related factors should be integrated into health care planning strategies and improvement initiatives to ensure equitable access and better quality of health care services.
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Affiliation(s)
- Dima Touhami
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Swiss Paraplegic Research, Nottwil, Switzerland.
| | - Stefan Essig
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Centre for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
| | | | - Anke Scheel-Sailer
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Armin Gemperli
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Swiss Paraplegic Research, Nottwil, Switzerland; Centre for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
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McIntyre A, Janzen S, Shepherd L, Kerr M, Booth R. An integrative review of adult patient-reported reasons for non-urgent use of the emergency department. BMC Nurs 2023; 22:85. [PMID: 36991388 DOI: 10.1186/s12912-023-01251-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE To conduct an integrative review of the scientific literature to explore adult patient-reported reasons for using the emergency department (ED) non-urgently. METHOD A literature search of CINAHL, Cochrane, Embase, PsycINFO, and MEDLINE was conducted with filters for humans, published January 1, 1990-September 1, 2021, and English language. Methodological quality was assessed using Critical Appraisal Skills Programme Qualitative Checklist for qualitative and National Institutes Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies for quantitative studies. Data was abstracted on study and sample characteristics, and themes/reasons for ED use. Cited reasons were coded using thematic analysis. RESULTS Ninety-three studies met inclusion criteria. Seven themes were found: need to be risk averse with respect to the health issue; knowledge and awareness of alternative sources of care; dissatisfaction with primary care provider; satisfaction with ED; ED accessibility and convenience resulting in low access burden; referred to the ED by others; and relationships between patients and health care providers. DISCUSSION This integrative review examined patient-reported reasons for attending the ED on a non-urgent basis. The results suggest that ED patients are heterogenous and many factors influence their decision-making. Considering the complexity with which patients live, treating them as a single entity may be problematic. Limiting excessive non-urgent visits likely requires a multi-pronged approach. CONCLUSION For many ED patients, they have a very clear problem which needed to be addressed. Future studies should explore psychosocial factors driving decision-making (e.g., health literacy, health-related personal beliefs, stress and coping ability).
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Affiliation(s)
- Amanda McIntyre
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, Canada.
- Department of Emergency Medicine, University Hospital, London Health Sciences Centre, London, Canada.
| | | | - Lisa Shepherd
- Department of Emergency Medicine, University Hospital, London Health Sciences Centre, London, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Mickey Kerr
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, Canada
| | - Richard Booth
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, Canada
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Strauß A, Zimmermann T, Schäfer I, Scherer M. Gesundheitskompetenz und Hausarztbindung nicht dringlicher Patientinnen und Patienten in Notaufnahmen: Ergebnisse der PiNo-Studie in Hamburg und Schleswig-Holstein. ZEITSCHRIFT FÜR EVIDENZ, FORTBILDUNG UND QUALITÄT IM GESUNDHEITSWESEN 2022; 175:50-58. [DOI: 10.1016/j.zefq.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/25/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022]
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Homburg I, Morreel S, Verhoeven V, Monsieurs KG, Meysman J, Philips H, De Graeve D. Non-compliance with a nurse's advice to visit the primary care provider: an exploratory secondary analysis of the TRIAGE-trial. BMC Health Serv Res 2022; 22:463. [PMID: 35395840 PMCID: PMC8994354 DOI: 10.1186/s12913-022-07904-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/28/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND During the cluster randomised TRIAGE-trial, a nurse advised 13% of low-risk patients presenting at an emergency department in Belgium to visit the adjacent general practitioner cooperative. Patients had the right to refuse this advice. This exploratory study examines the characteristics of refusers by uncovering the determinants of non-compliance and its impact on costs, as charged on the patient's invoice. METHODS Bivariate analyses with logistic regressions and T-tests were used to test the differences in patient characteristics, patient status, timing characteristics, and costs between refusers and non-refusers. A chi-square automatic interaction detection analysis was used to find the predictors of non-compliance. RESULTS 23.50% of the patients refused the advice to visit the general practitioner cooperative. This proportion was mainly influenced by the nurse on duty (non-compliance rates per nurse ranging from 2.9% to 52.8%) and the patients' socio-economic status (receiving increased reimbursement versus not OR 1.37, 95%CI: 0.96 to 1.95). Additionally, non-compliance was associated (at the 0.10 significance level) with being male, not living nearby and certain reasons for encounter. Fewer patients refused when the nurse perceived crowding level as quiet relative to normal, and more patients refused during the evening. The mean cost was significantly higher for patients who refused, which was a result of more extensive examination and higher out-of-pocket expenses at the ED. CONCLUSIONS The nurse providing the advice to visit the general practitioner cooperative has a central role in the likelihood of patients' refusal. Interventions to reduce non-compliance should aim at improving nurse-patient communication. Special attention may be required when managing patients with a lower socio-economic status. The overall mean cost was higher for refusers, illustrating the importance of compliance. TRIAL REGISTRATION The trial was registered on registration number NCT03793972 on 04/01/2019.
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Affiliation(s)
- Ines Homburg
- Department of Economics, University of Antwerp, Antwerp, Belgium.
| | - Stefan Morreel
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
| | - Veronique Verhoeven
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
| | - Koenraad G Monsieurs
- Department ASTARC, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Jasmine Meysman
- Department of Economics, University of Antwerp, Antwerp, Belgium
| | - Hilde Philips
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
| | - Diana De Graeve
- Department of Economics, University of Antwerp, Antwerp, Belgium
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Kolk D, Kruiswijk AF, MacNeil-Vroomen JL, Ridderikhof ML, Buurman BM. Older patients' perspectives on factors contributing to frequent visits to the emergency department: a qualitative interview study. BMC Public Health 2021; 21:1709. [PMID: 34544405 PMCID: PMC8454044 DOI: 10.1186/s12889-021-11755-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older patients are at high risk of unplanned revisits to the emergency department (ED) because of their medical complexity. To reduce the number of ED visits, we need more knowledge about the patient-level, environmental, and healthcare factors involved. The aim of this study was to describe older patients' perspectives and experiences before and after an ED visit, and to identify factors that possibly contribute to frequent ED revisits. METHODS This was a qualitative description study. We performed semi-structured individual interviews with older patients who frequently visited the ED and were discharged home after an acute visit. Patients were enrolled in the ED of a university medical centre using purposive sampling. Interviews were recorded, transcribed, and coded independently by two researchers. Theoretical analysis was used to identify recurring patterns and themes in the data. Interviews were conducted until thematic saturation was reached. RESULTS In-depth interviews were completed with 13 older patients. Three main themes emerged: 1) medical events leading to feelings of crisis, 2) patients' untreated health problems, and 3) persistent problems in health and daily functioning post discharge. Participants identified problems before and after their ED visit that possibly contributed to further ED visits. These problems included increasing symptoms leading to feelings of crisis, the relationship with the general practitioner, incomplete discharge information at the ED, and inadequate follow-up and lack of recovery after an ED visit. CONCLUSIONS This qualitative study identified multiple factors that may contribute to frequent ED visits among older patients. Older patients in need of acute care might benefit from hospital-at-home interventions, or acute care provided by geriatric emergency teams in the primary care setting. Identifying frailty in the ED is needed to improve discharge communication and adequate follow-up is needed to improve recovery after an acute ED visit.
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Affiliation(s)
- Daisy Kolk
- Amsterdam UMC, University of Amsterdam, Emergency Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands. .,Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health, Meibergdreef 9, Amsterdam, Netherlands.
| | - Anton F Kruiswijk
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health, Meibergdreef 9, Amsterdam, Netherlands.,OLVG Hospital, Department of Geriatric Medicine, Amsterdam, the Netherlands
| | - Janet L MacNeil-Vroomen
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health, Meibergdreef 9, Amsterdam, Netherlands
| | - Milan L Ridderikhof
- Amsterdam UMC, University of Amsterdam, Emergency Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
| | - Bianca M Buurman
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health, Meibergdreef 9, Amsterdam, Netherlands.,ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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Mooss A, Myatt J, Goldman J, Alexander JA. Integrated care effectiveness for adults with co-occurring disorders. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-05-2020-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study examined effectiveness of an integrated care program on emergency department visits within a longitudinal sample of patients with both primary care and behavioral health diagnoses.Design/methodology/approachPatients with co-occurring disorders enrolled in an integrated care clinic and were followed over time to determine whether participation in the clinic, including engagement in wellness/peer services, predicted decreases in Emergency Department (ED) use. Associations between socio-demographic characteristics of patients and ED use were also analyzed.FindingsAfter 6 months, clinic patients had decreases in ED use that continued for twelve months, albeit to a lesser degree. Demographics and program services were not related to ED use; however, multiple associations existed between high ED utilizers, severe mental illness (SMI), substance use disorders (SUD) and non-retention in services.Research limitations/implicationsThe study lacked a comparison group and there was no distinction between avoidable and unavoidable ED visits. A small sample size across time points led to inconclusive post hoc findings.Originality/valueThis study explored effectiveness of primary care integration into a behavioral health clinic for persons with multiple morbidities. Although initial decreases in ED visits were present, results indicate that these models may not be effective for persons with SMI or SMI/SUD who are already high ED users. This study provides support for integrated care in reducing ED use among persons with multiple morbidities and calls for further research on designing effective integrated models for persons with SMI and SUD.
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Akbayram HT, Coskun E. Paediatric emergency department visits for non-urgent conditions: Can family medicine prevent this? Eur J Gen Pract 2020; 26:134-139. [PMID: 33025832 PMCID: PMC7580770 DOI: 10.1080/13814788.2020.1825676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In Turkey, family physicians serve only during office hours, while emergency services have 7/24 free access. Non-urgent patients commonly use Paediatric Emergency departments (PEDs). In Turkey, there is little evidence as to why emergency services are used instead of family medicine for non-urgent paediatric healthcare. Objectives To evaluate the causes and factors affecting non-urgent PED visits. To determine the reason for non-use of family medicine for non-urgent paediatric healthcare. Methods We conducted a cross-sectional study at Gaziantep University PED between April and May 2019. We administered a questionnaire to the parents of children (from one month to 16 years) triaged to non-urgent (level-5) using a 5-level triage system. Results A total of 457 parents were surveyed. The average patient age was 6.5 ± 4.7 years and 24.5% had a chronic disease. One-third of the parents (33.7%) considered their children’s condition ‘very urgent’. The most important reason for preferring PED (42.5%) instead of family physician or alternative health facilities was the thought that the condition of children would worsen. Two hundred fifty-three (55.4%) of the patients presented outside working hours. Although 58.9% of parents were satisfied with the family physician, most (67.8%) stated that they preferred other specialists rather than family physicians when the child had health problems. Fathers who were primary school graduates were more likely to prefer other specialists than family physicians. Conclusion Parents’ perception of urgency and the thought that their child’s condition will worsen are the main reasons for non-urgent using PED.
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Affiliation(s)
- Hatice Tuba Akbayram
- Department of Family Medicine, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Enes Coskun
- Department of Pediatrics, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
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Miller S, Gilbert S, Virani V, Wicks P. Patients' Utilization and Perception of an Artificial Intelligence-Based Symptom Assessment and Advice Technology in a British Primary Care Waiting Room: Exploratory Pilot Study. JMIR Hum Factors 2020; 7:e19713. [PMID: 32540836 PMCID: PMC7382011 DOI: 10.2196/19713] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND When someone needs to know whether and when to seek medical attention, there are a range of options to consider. Each will have consequences for the individual (primarily considering trust, convenience, usefulness, and opportunity costs) and for the wider health system (affecting clinical throughput, cost, and system efficiency). Digital symptom assessment technologies that leverage artificial intelligence may help patients navigate to the right type of care with the correct degree of urgency. However, a recent review highlighted a gap in the literature on the real-world usability of these technologies. OBJECTIVE We sought to explore the usability, acceptability, and utility of one such symptom assessment technology, Ada, in a primary care setting. METHODS Patients with a new complaint attending a primary care clinic in South London were invited to use a custom version of the Ada symptom assessment mobile app. This exploratory pilot study was conducted between November 2017 and January 2018 in a practice with 20,000 registered patients. Participants were asked to complete an Ada self-assessment about their presenting complaint on a study smartphone, with assistance provided if required. Perceptions on the app and its utility were collected through a self-completed study questionnaire following completion of the Ada self-assessment. RESULTS Over a 3-month period, 523 patients participated. Most were female (n=325, 62.1%), mean age 39.79 years (SD 17.7 years), with a larger proportion (413/506, 81.6%) of working-age individuals (aged 15-64) than the general population (66.0%). Participants rated Ada's ease of use highly, with most (511/522, 97.8%) reporting it was very or quite easy. Most would use Ada again (443/503, 88.1%) and agreed they would recommend it to a friend or relative (444/520, 85.3%). We identified a number of age-related trends among respondents, with a directional trend for more young respondents to report Ada had provided helpful advice (50/54, 93%, 18-24-year olds reported helpful) than older respondents (19/32, 59%, adults aged 70+ reported helpful). We found no sex differences on any of the usability questions fielded. While most respondents reported that using the symptom checker would not have made a difference in their care-seeking behavior (425/494, 86.0%), a sizable minority (63/494, 12.8%) reported they would have used lower-intensity care such as self-care, pharmacy, or delaying their appointment. The proportion was higher for patients aged 18-24 (11/50, 22%) than aged 70+ (0/28, 0%). CONCLUSIONS In this exploratory pilot study, the digital symptom checker was rated as highly usable and acceptable by patients in a primary care setting. Further research is needed to confirm whether the app might appropriately direct patients to timely care, and understand how this might save resources for the health system. More work is also needed to ensure the benefits accrue equally to older age groups.
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Henninger S, Spencer B, Pasche O. Importance of the GP-patient relationship. Eur J Gen Pract 2019; 25:245. [PMID: 31663404 PMCID: PMC6853241 DOI: 10.1080/13814788.2019.1679469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
| | - Brenda Spencer
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Pasche
- ForOm Nord Vaudois, Yverdon, Switzerland.,Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
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Philips H, Verhoeven V, Morreel S, Colliers A, Remmen R, Coenen S, Van Royen P. Information campaigns and trained triagists may support patients in making an appropriate choice between GP and emergency department. Eur J Gen Pract 2019; 25:243-244. [PMID: 31663392 PMCID: PMC6853219 DOI: 10.1080/13814788.2019.1675630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/30/2019] [Accepted: 09/04/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hilde Philips
- Department of Primary and Interdisciplinary Care (ELIZA), Gouverneur Kinsbergen Centrum, University of Antwerp, Wilrijk, Belgium
| | - Veronique Verhoeven
- Department of Primary and Interdisciplinary Care (ELIZA), Gouverneur Kinsbergen Centrum, University of Antwerp, Wilrijk, Belgium
| | - Stefan Morreel
- Department of Primary and Interdisciplinary Care (ELIZA), Gouverneur Kinsbergen Centrum, University of Antwerp, Wilrijk, Belgium
| | - Annelies Colliers
- Department of Primary and Interdisciplinary Care (ELIZA), Gouverneur Kinsbergen Centrum, University of Antwerp, Wilrijk, Belgium
| | - Roy Remmen
- Department of Primary and Interdisciplinary Care (ELIZA), Gouverneur Kinsbergen Centrum, University of Antwerp, Wilrijk, Belgium
| | - Samuel Coenen
- Department of Primary and Interdisciplinary Care (ELIZA), Gouverneur Kinsbergen Centrum, University of Antwerp, Wilrijk, Belgium
| | - Paul Van Royen
- Department of Primary and Interdisciplinary Care (ELIZA), Gouverneur Kinsbergen Centrum, University of Antwerp, Wilrijk, Belgium
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