Cargando…

Demand for emergency health service: factors associated with inappropriate use

BACKGROUND: The inappropriate use of emergency room (ER) service by patients with non-urgent health problems is a worldwide problem. Inappropriate ER use makes it difficult to guarantee access for real emergency cases, decreases readiness for care, produces negative spillover effects on the quality...

Descripción completa

Detalles Bibliográficos
Autores principales: Carret, Maria LV, Fassa, Anaclaudia G, Kawachi, Ichiro
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2034385/
https://www.ncbi.nlm.nih.gov/pubmed/17705873
http://dx.doi.org/10.1186/1472-6963-7-131
_version_ 1782137001874554880
author Carret, Maria LV
Fassa, Anaclaudia G
Kawachi, Ichiro
author_facet Carret, Maria LV
Fassa, Anaclaudia G
Kawachi, Ichiro
author_sort Carret, Maria LV
collection PubMed
description BACKGROUND: The inappropriate use of emergency room (ER) service by patients with non-urgent health problems is a worldwide problem. Inappropriate ER use makes it difficult to guarantee access for real emergency cases, decreases readiness for care, produces negative spillover effects on the quality of emergency services, and raises overall costs. METHODS: We conducted a cross-sectional study in a medium-sized city in southern Brazil. The urgency of the presenting complaint was defined according to the Hospital Urgencies Appropriateness Protocol (HUAP). Multivariable Poisson regression was carried out to examine factors associated with inappropriate ER use. RESULTS: The study interviewed 1,647 patients over a consecutive 13-day sampling period. The prevalence of inappropriate ER use was 24.2% (95% CI 22.1–26.3). Inappropriate ER use was inversely associated with age (P = 0.001), longer stay in the waiting room, longer duration of symptoms and morning shift. However, the determinants of inappropriate ER use differed according age groups (P value for interaction = 0.04). Within the younger age-group (15–49 years), inappropriate ER use was higher among females, patients who reported visiting the ER because there was no other place to go, patients reporting that the doctor at the regular place of care refused to attend to them without a prior appointment, and individuals who reported that the PHC clinic which they use is open for shorter periods during the day. Among older patients (50+ years), those with highest level of education, absence of self-reported chronic diseases and lack of social support were more likely to engage in higher inappropriate ER use. CONCLUSION: Efforts should be made to redirect inappropriate ER demand. Besides expanding access to, and improving the quality of primary and secondary care, it is important to mobilize social support for older patients, to enhance the relationship between different levels of care, as well as to develop campaigns to educate the public about the appropriate use of medical services.
format Text
id pubmed-2034385
institution National Center for Biotechnology Information
language English
publishDate 2007
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-20343852007-10-18 Demand for emergency health service: factors associated with inappropriate use Carret, Maria LV Fassa, Anaclaudia G Kawachi, Ichiro BMC Health Serv Res Research Article BACKGROUND: The inappropriate use of emergency room (ER) service by patients with non-urgent health problems is a worldwide problem. Inappropriate ER use makes it difficult to guarantee access for real emergency cases, decreases readiness for care, produces negative spillover effects on the quality of emergency services, and raises overall costs. METHODS: We conducted a cross-sectional study in a medium-sized city in southern Brazil. The urgency of the presenting complaint was defined according to the Hospital Urgencies Appropriateness Protocol (HUAP). Multivariable Poisson regression was carried out to examine factors associated with inappropriate ER use. RESULTS: The study interviewed 1,647 patients over a consecutive 13-day sampling period. The prevalence of inappropriate ER use was 24.2% (95% CI 22.1–26.3). Inappropriate ER use was inversely associated with age (P = 0.001), longer stay in the waiting room, longer duration of symptoms and morning shift. However, the determinants of inappropriate ER use differed according age groups (P value for interaction = 0.04). Within the younger age-group (15–49 years), inappropriate ER use was higher among females, patients who reported visiting the ER because there was no other place to go, patients reporting that the doctor at the regular place of care refused to attend to them without a prior appointment, and individuals who reported that the PHC clinic which they use is open for shorter periods during the day. Among older patients (50+ years), those with highest level of education, absence of self-reported chronic diseases and lack of social support were more likely to engage in higher inappropriate ER use. CONCLUSION: Efforts should be made to redirect inappropriate ER demand. Besides expanding access to, and improving the quality of primary and secondary care, it is important to mobilize social support for older patients, to enhance the relationship between different levels of care, as well as to develop campaigns to educate the public about the appropriate use of medical services. BioMed Central 2007-08-18 /pmc/articles/PMC2034385/ /pubmed/17705873 http://dx.doi.org/10.1186/1472-6963-7-131 Text en Copyright © 2007 Carret et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Carret, Maria LV
Fassa, Anaclaudia G
Kawachi, Ichiro
Demand for emergency health service: factors associated with inappropriate use
title Demand for emergency health service: factors associated with inappropriate use
title_full Demand for emergency health service: factors associated with inappropriate use
title_fullStr Demand for emergency health service: factors associated with inappropriate use
title_full_unstemmed Demand for emergency health service: factors associated with inappropriate use
title_short Demand for emergency health service: factors associated with inappropriate use
title_sort demand for emergency health service: factors associated with inappropriate use
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2034385/
https://www.ncbi.nlm.nih.gov/pubmed/17705873
http://dx.doi.org/10.1186/1472-6963-7-131
work_keys_str_mv AT carretmarialv demandforemergencyhealthservicefactorsassociatedwithinappropriateuse
AT fassaanaclaudiag demandforemergencyhealthservicefactorsassociatedwithinappropriateuse
AT kawachiichiro demandforemergencyhealthservicefactorsassociatedwithinappropriateuse