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Motives for self-referral to the emergency department: a systematic review of the literature

BACKGROUND: In several western countries patients’ use of Emergency Departments (EDs) is increasing. A substantial number of patients is self-referred, but does not need emergency care. In order to have more influence on unnecessary self-referral, it is essential to know why patients visit the ED wi...

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Autores principales: Kraaijvanger, Nicole, van Leeuwen, Henk, Rijpsma, Douwe, Edwards, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5148909/
https://www.ncbi.nlm.nih.gov/pubmed/27938366
http://dx.doi.org/10.1186/s12913-016-1935-z
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author Kraaijvanger, Nicole
van Leeuwen, Henk
Rijpsma, Douwe
Edwards, Michael
author_facet Kraaijvanger, Nicole
van Leeuwen, Henk
Rijpsma, Douwe
Edwards, Michael
author_sort Kraaijvanger, Nicole
collection PubMed
description BACKGROUND: In several western countries patients’ use of Emergency Departments (EDs) is increasing. A substantial number of patients is self-referred, but does not need emergency care. In order to have more influence on unnecessary self-referral, it is essential to know why patients visit the ED without referral. The goal of this systematic review therefore is to explore what motivates self-referred patients in those countries to visit the ED. METHODS: Recommendations from the PRISMA were used to search and analyze the literature. The following databases; PUBMED, MEDLINE, EMBASE, CINAHL and Cochrane Library, were systematically searched from inception up to the first of February 2015. The reference lists of the included articles were screened for additional relevant articles. All studies that reported on the motives of self-referred patients to visit an ED were selected. The reasons for self-referral were categorized into seven main themes: health concerns, expected investigations; convenience of the ED; lesser accessibility of primary care; no confidence in general practitioner/primary care; advice from others and financial considerations. A random-effects meta-analysis was performed. RESULTS: Thirty publications were identified from the literature studied. The most reported themes for self-referral were ‘health concerns’ and ‘expected investigations’: 36% (95% Confidence Interval 23–50%) and 35% (95% CI 20-51%) respectively. Financial considerations most often played a role in the United States with a reported percentage of 33% versus 4% in other countries (p < 0.001). CONCLUSIONS: Worldwide, the most important reasons to self-refer to an ED are health concerns and expected investigations. Financial considerations mainly play a role in the United States.
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spelling pubmed-51489092016-12-16 Motives for self-referral to the emergency department: a systematic review of the literature Kraaijvanger, Nicole van Leeuwen, Henk Rijpsma, Douwe Edwards, Michael BMC Health Serv Res Research Article BACKGROUND: In several western countries patients’ use of Emergency Departments (EDs) is increasing. A substantial number of patients is self-referred, but does not need emergency care. In order to have more influence on unnecessary self-referral, it is essential to know why patients visit the ED without referral. The goal of this systematic review therefore is to explore what motivates self-referred patients in those countries to visit the ED. METHODS: Recommendations from the PRISMA were used to search and analyze the literature. The following databases; PUBMED, MEDLINE, EMBASE, CINAHL and Cochrane Library, were systematically searched from inception up to the first of February 2015. The reference lists of the included articles were screened for additional relevant articles. All studies that reported on the motives of self-referred patients to visit an ED were selected. The reasons for self-referral were categorized into seven main themes: health concerns, expected investigations; convenience of the ED; lesser accessibility of primary care; no confidence in general practitioner/primary care; advice from others and financial considerations. A random-effects meta-analysis was performed. RESULTS: Thirty publications were identified from the literature studied. The most reported themes for self-referral were ‘health concerns’ and ‘expected investigations’: 36% (95% Confidence Interval 23–50%) and 35% (95% CI 20-51%) respectively. Financial considerations most often played a role in the United States with a reported percentage of 33% versus 4% in other countries (p < 0.001). CONCLUSIONS: Worldwide, the most important reasons to self-refer to an ED are health concerns and expected investigations. Financial considerations mainly play a role in the United States. BioMed Central 2016-12-09 /pmc/articles/PMC5148909/ /pubmed/27938366 http://dx.doi.org/10.1186/s12913-016-1935-z Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Kraaijvanger, Nicole
van Leeuwen, Henk
Rijpsma, Douwe
Edwards, Michael
Motives for self-referral to the emergency department: a systematic review of the literature
title Motives for self-referral to the emergency department: a systematic review of the literature
title_full Motives for self-referral to the emergency department: a systematic review of the literature
title_fullStr Motives for self-referral to the emergency department: a systematic review of the literature
title_full_unstemmed Motives for self-referral to the emergency department: a systematic review of the literature
title_short Motives for self-referral to the emergency department: a systematic review of the literature
title_sort motives for self-referral to the emergency department: a systematic review of the literature
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5148909/
https://www.ncbi.nlm.nih.gov/pubmed/27938366
http://dx.doi.org/10.1186/s12913-016-1935-z
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