Patient, Provider Views of Why Patients Seek Care in EDs
Patient, Provider Views of Why Patients Seek Care in EDs
Background: Little is known about why patients choose emergency departments (EDs) to receive care.
Objective: Our aim was to measure the distribution and frequency of the stated reasons why patients choose the ED for care and why primary care physicians (PCPs) think their patients utilize the ED.
Methods: The authors conducted a survey of patients presenting to an ED with 92,000 annual visits. Appropriate parametric tests were used for univariate and multivariate analysis and results were presented as frequencies with 95% confidence intervals. The authors also performed a cross-sectional survey of PCPs through a web-based survey.
Results: Of the 1515 patients approached, 1083 (71%) agreed to participate and 1062 (98%) of them completed the survey. The most common reason patients gave for coming to the ED was their belief that their problem was serious (61%), followed by being referred (35%). In addition, 48% came at the advice of a provider, family member, or friend. By self-report, 354 (33%) patients attempted to reach their PCPs and 306 (86%) of them were successful. Two hundred and seventy-five PCPs were also surveyed. The most frequent reasons PCPs thought their patients came to an ED were that the patient chose to go on their own (80%) and the patients felt that they were too sick to be seen in the PCP's office (80%).
Conclusions: The majority of patients stated that the most common reason for seeking care in an ED was that they thought their problem was serious. Almost half sought ED care on the advice of a family member, friend, or health care provider, and a sizable minority were actually referred in by a health care provider. PCPs agree that most patients come to EDs because they believe they are too sick to be seen in their office or become sick after office hours.
In 2007, according to the Centers for Disease Control and Prevention (CDC; cdc.gov), there were 117 million visits to emergency departments (EDs) across the United States. This represents an increase of 1 million visits since 2005. This trend has been largely ascribed to the growing number of medically uninsured individuals. However, in Massachusetts, despite near-universal health care, ED visits continue to rise, suggesting that access and constraints on provider capacity, rather than insurance status, serve as the key drivers of ED use. Given the national shortage of primary care providers (PCPs), the Massachusetts experience may predict ED use nationwide if the universal health insurance provisions of the recent health care reform law go into effect.
Impacted by progressive increases in patient volume, ED crowding continues to be a significant issue. In a 2006 survey of medical directors, 90% of hospital directors reported ED crowding, suggesting that ED crowding is a problem in virtually every state. In addition to long waits and the frustration of personnel and patients, ED crowding also leads to a greater risk of poor health outcomes. For instance, treatment wait times have been found to be longer for pneumonia patients in crowded EDs.
In summary, ED volume continues to rise and contributes to ED overcrowding, but very few studies have attempted to measure the patients' perspectives on why they chose the ED to receive their medical care. Even less is known about whether patients had been referred to the ED by a PCP and, if so, why. The study objective was to measure the distribution and frequency of the stated reasons why patients chose the ED for their care. A secondary goal was to measure the distribution and frequency of the reasons why PCPs thought their patients utilized the ED.
Abstract and Introduction
Abstract
Background: Little is known about why patients choose emergency departments (EDs) to receive care.
Objective: Our aim was to measure the distribution and frequency of the stated reasons why patients choose the ED for care and why primary care physicians (PCPs) think their patients utilize the ED.
Methods: The authors conducted a survey of patients presenting to an ED with 92,000 annual visits. Appropriate parametric tests were used for univariate and multivariate analysis and results were presented as frequencies with 95% confidence intervals. The authors also performed a cross-sectional survey of PCPs through a web-based survey.
Results: Of the 1515 patients approached, 1083 (71%) agreed to participate and 1062 (98%) of them completed the survey. The most common reason patients gave for coming to the ED was their belief that their problem was serious (61%), followed by being referred (35%). In addition, 48% came at the advice of a provider, family member, or friend. By self-report, 354 (33%) patients attempted to reach their PCPs and 306 (86%) of them were successful. Two hundred and seventy-five PCPs were also surveyed. The most frequent reasons PCPs thought their patients came to an ED were that the patient chose to go on their own (80%) and the patients felt that they were too sick to be seen in the PCP's office (80%).
Conclusions: The majority of patients stated that the most common reason for seeking care in an ED was that they thought their problem was serious. Almost half sought ED care on the advice of a family member, friend, or health care provider, and a sizable minority were actually referred in by a health care provider. PCPs agree that most patients come to EDs because they believe they are too sick to be seen in their office or become sick after office hours.
Introduction
In 2007, according to the Centers for Disease Control and Prevention (CDC; cdc.gov), there were 117 million visits to emergency departments (EDs) across the United States. This represents an increase of 1 million visits since 2005. This trend has been largely ascribed to the growing number of medically uninsured individuals. However, in Massachusetts, despite near-universal health care, ED visits continue to rise, suggesting that access and constraints on provider capacity, rather than insurance status, serve as the key drivers of ED use. Given the national shortage of primary care providers (PCPs), the Massachusetts experience may predict ED use nationwide if the universal health insurance provisions of the recent health care reform law go into effect.
Impacted by progressive increases in patient volume, ED crowding continues to be a significant issue. In a 2006 survey of medical directors, 90% of hospital directors reported ED crowding, suggesting that ED crowding is a problem in virtually every state. In addition to long waits and the frustration of personnel and patients, ED crowding also leads to a greater risk of poor health outcomes. For instance, treatment wait times have been found to be longer for pneumonia patients in crowded EDs.
In summary, ED volume continues to rise and contributes to ED overcrowding, but very few studies have attempted to measure the patients' perspectives on why they chose the ED to receive their medical care. Even less is known about whether patients had been referred to the ED by a PCP and, if so, why. The study objective was to measure the distribution and frequency of the stated reasons why patients chose the ED for their care. A secondary goal was to measure the distribution and frequency of the reasons why PCPs thought their patients utilized the ED.
