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Psychosocial factors influencing non-urgent use of the emergency room: A review of the literature and recommendations for research and improved service delivery

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  • Padgett, Deborah K.
  • Brodsky, Beth

Abstract

Despite dramatic increases in use of hospital emergency rooms (ERs) since the 1950s, an estimated 85% of ER visits are made for non-life-threatening reasons. Using a modified version of the Andersen and Newman model of health care utilization, this paper reviews the research literature on ER use to examine what is known about factors that influence three stages of the help-seeking process: (1) problem recognition; (2) the decision to seek help; (3) the decision to use the ER. While predisposing factors other than race are not generally significant, enabling factors such as income, insurance coverage, having a usual source of care, and geographic proximity affect use of the ER, both alone and in interaction with race and other factors. The most common reason for non-urgent ER use was 'other care not available'. In addition to the absence of primary care, non-urgent use of the ER is linked to need factors arising from socioeconomic stress, psychiatric co-morbidities, and a lack of social support. Recommendations for future studies include examining prospectively all 3 stages of decision-making leading to ER use, and considering interactive effects among predictors. Implications for service delivery are discussed, including the need to re-structure health care delivery systems to provide greater access to primary care and provide more attention to psychosocial aspects of patient care in clinical settings.

Suggested Citation

  • Padgett, Deborah K. & Brodsky, Beth, 1992. "Psychosocial factors influencing non-urgent use of the emergency room: A review of the literature and recommendations for research and improved service delivery," Social Science & Medicine, Elsevier, vol. 35(9), pages 1189-1197, November.
    • Handle: RePEc:eee:socmed:v:35:y:1992:i:9:p:1189-1197
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    Citations

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    Cited by:

    1. Man Jiang & Guang Yang & Lvying Fang & Jin Wan & Yinghua Yang & Ying Wang, 2018. "Factors associated with healthcare utilization among community-dwelling elderly in Shanghai, China," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-22, December.
    2. Smith, Samantha, 2007. "Emergency Department Utilisation in Four Irish Teaching Hospitals," Papers HRBWP26, Economic and Social Research Institute (ESRI).
    3. Neil, Amanda L. & Chappell, Kate & Wagg, Fiona & Miller, April & Judd, Fiona, 2021. "The Tasmanian Conception to Community (C2C) Study Database 2008-09 to 2013-14: Using linked health administrative data to address each piece in the puzzle," Social Science & Medicine, Elsevier, vol. 284(C).
    4. Nerina Vecchio & Nicholas Rohde, 2017. "The effect of inadequate access to healthcare services on emergency room visits in Australia," Discussion Papers in Economics economics:201708, Griffith University, Department of Accounting, Finance and Economics.
    5. de Boer, Angela G. E. M. & Wijker, Wouter & de Haes, Hanneke C. J. M., 1997. "Predictors of health care utilization in the chronically ill: a review of the literature," Health Policy, Elsevier, vol. 42(2), pages 101-115, November.
    6. Christian T. Braun & Cornelia R. Gnägi & Jolanta Klukowska-Rötzler & Sufian S. Ahmad & Meret E. Ricklin & Aristomenis K. Exadaktylos, 2017. "Trends and Weekly Cycles in a Large Swiss Emergency Centre: A 10 Year Period at the University Hospital of Bern," IJERPH, MDPI, vol. 14(10), pages 1-12, October.
    7. Veazie, Peter & Denham, Alina, 2021. "Understanding how psychosocial factors relate to seeking medical care among older adults using a new model of care seeking," Social Science & Medicine, Elsevier, vol. 281(C).
    8. Lega, Federico & Mengoni, Alessandro, 2008. "Why non-urgent patients choose emergency over primary care services? Empirical evidence and managerial implications," Health Policy, Elsevier, vol. 88(2-3), pages 326-338, December.
    9. Eiman Jahangir & Vilma Irazola & Adolfo Rubinstein, 2012. "Need, Enabling, Predisposing, and Behavioral Determinants of Access to Preventative Care in Argentina: Analysis of the National Survey of Risk Factors," PLOS ONE, Public Library of Science, vol. 7(9), pages 1-6, September.
    10. Hélène Colineaux & Fanny Le Querrec & Laure Pourcel & Jean-Christophe Gallart & Olivier Azéma & Thierry Lang & Michelle Kelly-Irving & Sandrine Charpentier & Sébastien Lamy, 2018. "Is the use of emergency departments socially patterned?," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 63(3), pages 397-407, April.
    11. Genevieve E O'Connor, 2016. "Investigating the significance of insurance and income on health service utilization across generational cohorts," Journal of Financial Services Marketing, Palgrave Macmillan, vol. 21(1), pages 19-33, March.
    12. Roberts, Emilie & Mays, Nicholas, 1998. "Can primary care and community-based models of emergency care substitute for the hospital accident and emergency (A & E) department?," Health Policy, Elsevier, vol. 44(3), pages 191-214, June.
    13. Refael Hassin & Ricky Roet-Green, 2017. "The Impact of Inspection Cost on Equilibrium, Revenue, and Social Welfare in a Single-Server Queue," Operations Research, INFORMS, vol. 65(3), pages 804-820, June.

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