Why do people choose Emergency and Urgent care services? A rapid review utilizing a systematic literature search and narrative synthesis

Abstract

Objectives

Rising demand for emergency and urgent care services are well documented, as are the consequences, for example, ED crowding, increased costs, pressure on services and waiting times. Multiple factors have been suggested to explain why demand is increasing, including an aging population, rising number of people with multiple chronic conditions and behavioural changes relating to how people choose to access health services. The aim of this systematic mapping review is to bring together published research from urgent and emergency care settings to identify drivers that underpin patient decisions to access urgent and emergency care.

Methods

Systematic searches were conducted across MEDLINE (via Ovid SP), EMBASE (via Ovid), The Cochrane Library (via Wiley Online Library), Web of Science (via the Web of Knowledge) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; via EBSCOhost. Peer reviewed studies written in English that reported reasons for accessing or choosing emergency or urgent care services, and were published between 1995 and 2016 were included. Data were extracted and reasons for choosing emergency and urgent care were identified and mapped. Thematic analysis was used to identify themes and findings were reported qualitatively using framework based narrative synthesis.

Results

Thirty-eight studies were identified that met the inclusion criteria. Most studies were set in the UK (39.4%) or the USA (34.2%)and reported results relating to ED (68.4%).Thirty-nine percent of studies utilised qualitative or mixed research designs Our thematic analysis identified 6 broad themes which summarised reasons why patients chose to access ED or urgent care. These were access to and confidence in primary care; perceived urgency, anxiety and the value of reassurance from emergency based services; views of family, friends or healthcare professionals; convenience (location, not having to make appointment and opening hours); individual patient factors (e.g. cost); perceived need for EMS or hospital care, treatment or investigations.

Conclusions

We identified 6 distinct reasons explaining why patients choose to access emergency and urgent care services: Limited access to or confidence in primary care, patient perceived urgency, convenience, views of family, friends or other health professionals and a belief that their condition required the resources and facilities offered by a particular healthcare provider. There is a need to examine demand from a whole system perspective to gain better understanding of demand for different parts of the emergency and urgent care system and the characteristics of patients within each sector.

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