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Factors associated with non-urgent utilization of Accident and Emergency services: a case-control study in Hong Kong

Author

Listed:
  • Lee, Albert
  • Lau, Fei-Lung
  • Hazlett, Clarke B.
  • Kam, Chak-Wah
  • Wong, Patrick
  • Wong, Tai-Wai
  • Chow, Susan

Abstract

Accident and Emergency Departments (A&E) have been a popular source of primary care, and studies have shown that up to two thirds of patients attending A&E have problems that could be managed by general practitioners (GPs). Although many studies have found that patients of lower socio-economic class with less social support have a higher utilization rate of A&E, some recent studies have revealed contrary evidence. In this study 2410 patients were randomly selected from four A&E at different times. The gold standard in differentiating true emergency cases and GP cases was based on a retrospective record review conducted independently by a panel of emergency physicians. Two emergency physicians reviewed each case independently, and if their independent ratings were in agreement, this became the gold standard. Patients classified as GP cases were given a telephone interview, and a sample was selected and matched with cases from general out patient clinics (GOPC) in the public sector by morbidity. Reasons for not attending a private GP included closure of clinic, deterioration of symptoms, GPs' inability to diagnose properly, and patients' wish to continue medical treatment in the same hospital. Reasons why non-urgent patients did not choose to attend the nearby public GOPC included affordability, closure of the GOPC, patients' wish to continue treatment at the same hospital, GOPC too far away, no improvement shown after visits to GOPC doctors, and GOPC doctors' inability to make proper diagnoses. The reasons for high level of utilization of A&E services are complex and reflect problems of delivery of GP services. There is an urgent need for GPs to set up a network system to provide out of hours services, and also for a better interfacing between primary and secondary care, and between public and private sectors, so that patients can be referred back to GPs. Interim clinical services provided to those non-urgent cases by nursing practitioners or by GPs working in A&E could also facilitate discharge of patients to primary care facilities.

Suggested Citation

  • Lee, Albert & Lau, Fei-Lung & Hazlett, Clarke B. & Kam, Chak-Wah & Wong, Patrick & Wong, Tai-Wai & Chow, Susan, 2000. "Factors associated with non-urgent utilization of Accident and Emergency services: a case-control study in Hong Kong," Social Science & Medicine, Elsevier, vol. 51(7), pages 1075-1085, October.
  • Handle: RePEc:eee:socmed:v:51:y:2000:i:7:p:1075-1085
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    Citations

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    Cited by:

    1. Gansel, Yannis & Danet, François & Rauscher, Catherine, 2010. "Long-stay inpatients in short-term emergency units in France: A case study," Social Science & Medicine, Elsevier, vol. 70(4), pages 501-508, February.
    2. Salhi, Bisan A., 2020. "Who are Clive's friends? Latent sociality in the emergency department," Social Science & Medicine, Elsevier, vol. 245(C).
    3. 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.
    4. Broekman, S.M. & Gils- van Rooij, E.S.J. & Meijboom, B.R. & Yzermans, C.J., 2017. "Do out-of-hours GP services and emergency departments cost more by collaborating, or by working separately? : A cost analysis," Other publications TiSEM e313955c-a62e-4b27-b0ee-b, Tilburg University, School of Economics and Management.
    5. 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.
    6. Albert Lee & Hoi-wai Chua & Mariana Chan & Patrick W L Leung & Jasmine W S Wong & Antonio A T Chuh, 2015. "Health Disparity Still Exists in an Economically Well-Developed Society in Asia," PLOS ONE, Public Library of Science, vol. 10(6), pages 1-16, June.
    7. Lippi Bruni, Matteo & Mammi, Irene & Ugolini, Cristina, 2016. "Does the extension of primary care practice opening hours reduce the use of emergency services?," Journal of Health Economics, Elsevier, vol. 50(C), pages 144-155.

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