Article Text

Use of healthcare information and advice among non-urgent patients visiting emergency department or primary care
  1. Ann-Sofie Backman1,
  2. Magdalena Lagerlund2,
  3. Tobias Svensson1,
  4. Paul Blomqvist1,
  5. Johanna Adami1
  1. 1Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
  2. 2Department of Medical Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
  1. Correspondence to Dr Ann-Sofie Backman, Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Eugeniahemmet, T2 SE-171 76 Solna, Sweden; ann-sofie.backman{at}karolinska.se

Abstract

Background Healthcare information provided by telephone service and internet sources is growing but has not been shown to reduce inappropriate emergency department (ED) visits.

Objective To describe the use of advice or healthcare information among patients with non-urgent illnesses seeking care before attendance at an ED, or primary care (PC) centres in an urban region in Sweden.

Design Patients with non-urgent illnesses seeking care at an ED or patients attending the PC were followed up with a combination of patient interviews, a questionnaire to the treating physician and a prospective follow-up of healthcare use through a population-based registry.

Results Half of the non-urgent patients attending the ED had used healthcare information or advice before the visit, mainly from a healthcare professional source. In PC, men were more likely to have used information or advice compared with women (OR 2.5 95% CI 1.3 to 5.0), whereas the situation was reversed among ED patients (OR=0.4 95% CI 0.2 to 0.9). Men with no previous healthcare experience attending the ED had the lowest use of healthcare information (p<0.01). Very few in both groups had utilised healthcare information on the internet in a case of perceived emergency.

Conclusion ED patients rated as non-urgent by the triage nurse used more advice and healthcare information than PC patients, irrespective of the physician-rated urgency of the symptoms. The problem seems not to be lack of information about appropriate ED use, but to find ways to direct the information to the right target group.

  • Healthcare information
  • primary care
  • emergency department
  • non-urgent
  • clincial management
  • doctors in PHC
  • prehospital care
  • communications
  • emergency care systems
  • emergency department management

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Introduction

Lack of healthcare information is suggested as one explanation for ‘non-urgent’ or ‘inappropriate’ use of the emergency department (ED).1 ,2 Use of telephone consultation services for medical advice is growing, but has not been shown to reduce the demand at EDs.3 ,4

Our objective was to describe the use of advice and healthcare information before a non-urgent ED or unscheduled primary care (PC) visit.

Methods

We conducted a cross-sectional interview-based study comprising patients attending either the unscheduled PC reception or the ED. This was a part of a larger study which is described in detail elsewhere.5

The study was conducted in the catchment area of Södersjukhuset in Stockholm, Sweden, a public general hospital with 505 beds and some 100 000 adult attendances a year to the ED. Patients, aged 20–80 years, seeking care with non-urgent illnesses at the ED of Södersjukhuset or at either of eight PC centres in the same catchment area were eligible. Patients were recruited during two consecutive months, between 08:00 and 16:00 (online web appendix I).

The following information was collected for all patients in the study:

  1. Structured interview; patients' demographics, previous healthcare use, perceptions of their symptoms and duration of symptoms. The specific questions about seeking healthcare information are shown in table 1.

  2. Questionnaire; the physicians' perceptions regarding the patient's urgency.

  3. Registry; all healthcare contacts during 1 month after the index visit were recorded in a population-based registry. The variables are described in web appendix II.

Table 1

Questions concerning the patients' healthcare seeking behaviour

Descriptive, univariate and multivariate analyses were performed in Statistica release 8 and SAS V.9.1.3.

Results

During the study a total of 543 patients, 396 in the PC centres and 147 at the ED, were eligible for inclusion. A total of 428 patients (79%) were interviewed, had complete physicians' questionnaire and a full 30-day follow-up.

At the ED, 49% of the non-urgent patients had received advice or professional healthcare information before the choice of healthcare setting. The corresponding number for PC patients was 12% (table 1).

Women were more likely than men to attend PC without previous advice (OR=2.5, 95% CI 1.3 to 5.0). At the ED, the situation was the reverse (OR=0.4, 95% CI 0.2 to 0.9). Previous healthcare experience among PC patients was associated with less information seeking before the visit. The patient's age, employment status, education level, physician's perception of urgency, subsequent physician contacts, healthcare information use in the past, symptom duration and patient's perception of symptoms did not affect the use of information before attendance in PC or the ED.

Previous use of healthcare information in another urgent health-related situation was higher among women (OR=1.9, 95% CI 1.1 to 3.3), persons with employment (>75%) (OR=3.1, 95% CI 1.5 to 6.2) and patients with previous healthcare experience (OR=2.5, 95% CI 1.3 to 5.0).

Men with no previous healthcare experience attending the ED had the lowest use of healthcare information (p<0.01).

Discussion

Non-urgent ED patients used advice or professional healthcare information more often than patients attending the PC centres. Women were more prone to seek healthcare information or advice before attending the ED than men. Relying on family or friends for medical advice was common in both groups.

Few patients had ever used the internet to obtain information in an urgent healthcare matter which is supported by other recent studies.6 ,7

Studies on inappropriate use of the ED often conclude that it is necessary to educate the population about situations where an ED is the primary healthcare choice. These studies have mainly described only ED patients, without comparing them with other patient groups.1 ,8 ,9 We found that non-urgent ED patients seek healthcare information, which is supported by other studies reporting that up to 66% of the patients have sought advice before an ED visit.10

Conclusion

ED patients rated as non-urgent by the triage nurse used more advice and healthcare information than PC patients before attendance, but young, previously healthy men had used least information. The problem seems not to be lack of information about appropriate ED use, but to find ways to reach the right target group.

References

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Files in this Data Supplement:

Footnotes

  • Funding This study was supported by a grant from Stockholm County Council, Stockholm, Sweden.

  • Competing interests None.

  • Ethics approval The study was approved by the Institutional review board at Karolinska Institutet, Stockholm, Sweden (Dnr 441/01).

  • Provenance and peer review Not commissioned; internally peer reviewed.

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