Volume 178 - Issue 4
Inappropriate use of hospital emergency departments
Authors: Michael K Marks, Daniel Steinfort and Peter LJ Barnett
Med J Aust 2003; 178 (4): 187-188. || doi: 10.5694/j.1326-5377.2003.tb05142.x
Published online: 17 February 2003
Published online: 17 February 2003
To the Editor: Both adult and paediatric hospital emergency departments (EDs) are subject to inappropriate use.1,2,3 Some families use the ED as a primary care provider,4,5 often claiming that they have no regular general practitioner.6 Such families may experience poorer overall health.7,8 We hypothesised that providing such families with information about GPs in their area and emphasising the benefits of having a GP responsible for their long term healthcare might:
facilitate the establishment of ongoing relationships between patients and GPs; and
encourage families to use GPs more as their primary source of care.
We conducted a controlled trial (week-on, week-off randomisation) of families identified as having no regular GP who presented to the Royal Children's Hospital ED over four months. Information about the GPs interested in seeing children was located on a computer database. Medical staff were able to search for a GP whose surgery was close to the patient's street address. Families were provided with detailed information about the GP's practice (eg, opening times, languages spoken, etc). Parents were given a list of GPs and a map showing the locations of their surgeries, together with a letter of introduction; the families decided which GP they would attend. Families in the control group were just treated as usual. Families were then contacted after two months to see if they had visited a GP and whether regular contact had been established.
Over the four months, 216 families were enrolled; 96 were allocated to the intervention group. Despite our active encouragement, the ED medical staff provided the intervention material to families in the intervention group on just 49% of occasions.
We found that, two months after the initial ED visit, intervention-group families were no more likely to have established an ongoing relationship with a GP than control families (46 [38.3%] and 41 [42.7%], respectively; P = 0.5), irrespective of whether or not they received the intervention material.
In summary, this single intervention was not sufficient to alter healthcare-seeking behaviour of families with no regular GP. It seems the motivation to obtain a GP lies with the family. Thus, it would seem necessary to design and deliver an intervention that addresses the beliefs of families about the roles of various facets of the healthcare system. With time and work pressures, ED medical staff may not be in the best position to provide such intervention.
References
- Keith AR, Pirkis JE, Viney RC, et al. Delivery of primary care in hospital and community settings in Australia. Qual Assur Health Care 1993; 5: 131-141. CBBFIGAF
- Weir R, Rideout E, Crook J. Pediatric use of emergency departments. J Pediatr Health Care 1989; 3: 204-210. CBBFIDIC
- Davies T. Accident department or general practice? BMJ (Clinical research ed.) 1986; 292: 241-243. i1082284
- Kini NM, Strait RT. Nonurgent use of the pediatric emergency department during the day. Pediatr Emerg Care 1998; 14: 19-21. i1082286
- Smith RD, McNamara JJ. Why not your pediatrician's office? A study of weekday pediatric emergency department use for minor illness care in a community hospital. Pediatr Emerg Care 1988; 4: 107-111. i1082288
- Shesser R, Kirsch T, Smith J, Hirsch R. An analysis of emergency department use by patients with minor illness. Ann Emerg Med 1991; 20: 743-748. i1082290
- Lambrew JM, DeFriese GH, Carey TS, et al. The effects of having a regular doctor on access to primary care. Med Care 1996; 34: 138-151. i1082292
- Baker DW, Stevens CD, Brook RH. Regular source of ambulatory care and medical utilization by patients presenting to a public hospital emergency department. JAMA 1994; 271(24): 1909-1912. i1082294