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Review
. 2020 Feb;23(1):19-40.
doi: 10.1111/hex.12995. Epub 2019 Oct 29.

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

Alicia O'Cathain  1 , Janice Connell  1 , Jaqui Long  1 , Joanne Coster  1
Affiliations
Review

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

Alicia O'Cathain et al. Health Expect. 2020 Feb.

Abstract

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.

Keywords: emergency medicine; heath care seeking behaviour; patients; urgent care.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Summary of search, selection and extraction of articles
Figure 2
Figure 2
Overview of contexts and mechanisms affecting use of emergency and urgent care
See this image and copyright information in PMC

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