‘Clinically unnecessary’ use of emergency and urgent care: A realist review of patients' decision making

Background Demand is labelled ‘clinically unnecessary’ when patients do not need the levels of clinical care or urgency provided by the service they contact. Objective To identify programme theories which seek to explain why patients make use of emergency and urgent care that is subsequently judged...

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Bibliographic Details
Published in:Health expectations : an international journal of public participation in health care and health policy Vol. 23; no. 1; pp. 19 - 40
Main Authors: O'Cathain, Alicia, Connell, Janice, Long, Jaqui, Coster, Joanne
Format: Journal Article
Language:English
Published: England John Wiley & Sons, Inc 01.02.2020
John Wiley and Sons Inc
Wiley
Subjects:
Access
Ambulatory Care
Anxiety
Behavior change
Behavior modification
Client satisfaction
Clinical decision making
Compliance
Coping
Customer satisfaction
Decision Making
Emergencies
Emergency medical care
Emergency medical services
emergency medicine
Emergency Service, Hospital
Emergency services
Experts
Family physicians
Frustration
Health behavior
Health care
Health care access
Health services
Health Services Misuse
Health services utilization
heath care seeking behaviour
Help seeking behavior
Humans
Medical decision making
Medical personnel
Minimization
Patient Acceptance of Health Care
Patient Preference
Patients
Primary care
Qualitative Research
Quantitative analysis
Quantitative research
Review
Risk Factors
Risk reduction
Satisfaction
Systematic review
Theory
Time Factors
Trauma
Traumatic life events
Treatment needs
Urgency
urgent care
urgent care
emergency medicine
heath care seeking behaviour
patients
ISSN:1369-6513, 1369-7625, 1369-7625
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Description
Summary:Background Demand is labelled ‘clinically unnecessary’ when patients do not need the levels of clinical care or urgency provided by the service they contact. Objective To identify programme theories which seek to explain why patients make use of emergency and urgent care that is subsequently judged as clinically unnecessary. Design Realist review. Methods Papers from four recent systematic reviews of demand for emergency and urgent care, and an updated search to January 2017. Programme theories developed using Context‐Mechanism‐Outcome chains identified from 32 qualitative studies and tested by exploring their relationship with existing health behaviour theories and 29 quantitative studies. Results Six mechanisms, based on ten interrelated programme theories, explained why patients made clinically unnecessary use of emergency and urgent care: (a) need for risk minimization, for example heightened anxiety due to previous experiences of traumatic events; (b) need for speed, for example caused by need to function normally to attend to responsibilities; (c) need for low treatment‐seeking burden, caused by inability to cope due to complex or stressful lives; (d) compliance, because family or health services had advised such action; (e) consumer satisfaction, because emergency departments were perceived to offer the desired tests and expertise when contrasted with primary care; and (f) frustration, where patients had attempted and failed to obtain a general practitioner appointment in the desired timeframe. Multiple mechanisms could operate for an individual. Conclusions Rather than only focusing on individuals' behaviour, interventions could include changes to health service configuration and accessibility, and societal changes to increase coping ability.
Bibliography:Funding information
This project was funded by the NIHR Health Services and Delivery Research (15/136/12). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The funder did not play a role in the review.
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PROSPERO 2017: https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017056273
ISSN:1369-6513
1369-7625
1369-7625
DOI:10.1111/hex.12995