QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Home | Help | Feedback | Subscriptions | Archive | Search | Table of Contents

This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (5) Citing Articles via Google Scholar Google Scholar Articles by Guttman, N. Articles by Nelson, M. S. Search for Related Content PubMed PubMed Citation

The Many Faces of Access: Reasons for Medically Nonurgent Emergency Department Visits

Deena R. Zimmerman
Maccabi Health Services and Terem Emergency Services, Jerusalem

Myra Schaub Nelson
Communication Health Care Consultant, New Jersey

Abstract.

Investigating why people use the hospital emergency department (ED) for visits considered medically nonurgent can enhance our understanding of people's expectations of health care services, of their conceptions of prudent lay judgment, and of difficulties in negotiating the logistics of primary care services. This study identified reasons for such ED use from users' perspectives in both pediatric and adult visits. Respondents were asked to explain what brought them to the ED and to define an emergency. The study was conducted in two northeastern U.S. hospital EDs. The analysis drew on a convenience sample of 408 (331 pediatric, 77 adult users) face-to-face interviews that employed both open- and closed-ended questions. Findings indicate most patients had medical insurance and a regular place of care and most arrived by car or taxi. Twelve main themes emerged under three main categories: conceptions of needs, appropriateness, and preference for the ED. The findings indicate that various reasons for ED use may be construed as access issues. These include beliefs regarding limited availability of after-hour consultation services and of timely appointments at one's primary care site. Drawing on the findings, a typology that distinguishes between groups of users according to their preference for the ED, a level of congruence between their own reason and their definition of an emergency was developed. The typology suggests that people's concerns that influence their decision to come tothe ED cannot be solved simply by expanding primary care services or by educational interventions. Its application yields recommendations for services and interventions.

This article has been cited by other articles:

				P. J. Cunningham What Accounts For Differences In The Use Of Hospital Emergency Departments Across U.S. Communities? Health Aff., September 1, 2006; 25(5): w324 - w336. [Abstract] [Full Text] [PDF]