Abstract
BackgroundWhilst many health systems offer a range of urgent and emergency care services to deal with the need for unscheduled care, these can be problematic to navigate.ObjectiveTo explore how lay people make sense of urgent care provision and processes.DesignQualitative study, incorporating citizen panels and longitudinal semi‐structured qualitative interviews.Setting and ParticipantsTwo citizens’ panels, comprising purposively selected public populations—a group of regular users and a group of potentially marginalized users of urgent and emergency care. Semi‐structured interviews were conducted with 100 people, purposively sampled to include those over 75, aged 18‐26 years, and from East/Central Europe. A sub‐sample of 41 people received a second interview at +6‐12 months. Framework analysis was thematic and comparative, moving through coding to narrative and interpretive summaries.Findings and DiscussionParticipants narratives illuminated considerable uncertainty and confusion regarding urgent and emergency care provision which in part could be traced to the contingent nature of urgent and emergency care need. Accounts of emergency care provision were underpinned by strong moral positioning of appropriate help‐seeking, demarcating legitimate service use that echoed policy rhetoric, but did not necessarily translate into individual behaviour. People struggled to make sense of urgent care provision making navigating “appropriate” use problematic.ConclusionsThe focus on help‐seeking behaviour, rather than sense‐making, makes it difficult to move beyond the polarization of “appropriate” and “inappropriate” service use. A deeper analysis of sense‐making might shift the focus of attention and allow us to intervene to reshape understandings before this point.
Highlights
In developed countries, including the UK, USA, Canada and Australia, urgent health-care services are often positioned in an ill-defined space somewhere between family or general practice (GP) and emergency hospital and ambulance care.[1,2,3] Urgent health-care services are primarily designed to assess and manage unscheduled or unforeseen conditions that arise in the out-of-hours period, providing care for people with pressing health-care needs which cannot wait until primary care services are available.[4]
We present the findings under four thematic headings (a) confusing boundaries of urgent care service provision, (b) contingent nature of need, (c) moral positioning in making sense of when and how to use urgent care and (d) re-imagined borders of urgent and emergency provision
The demand for urgent and emergency care services appears to be increasing, especially from particular groups of patients who share characteristics of those purposively chosen in this study.[48,49]
Summary
In developed countries, including the UK, USA, Canada and Australia, urgent health-care services are often positioned in an ill-defined space somewhere between family or general practice (GP) and emergency hospital and ambulance care.[1,2,3] Urgent health-care services are primarily designed to assess and manage unscheduled or unforeseen conditions that arise in the out-of-hours period, providing care for people with pressing health-care needs which cannot wait until primary care services are available.[4]. Whilst many health systems offer a range of urgent and emergency care services to deal with the need for unscheduled care, these can be problematic to navigate. Accounts of emergency care provision were underpinned by strong moral positioning of appropriate help-seeking, demarcating legitimate service use that echoed policy rhetoric, but did not necessarily translate into individual behaviour. People struggled to make sense of urgent care provision making navigating “appropriate” use problematic. Conclusions: The focus on help-seeking behaviour, rather than sense-m aking, makes it difficult to move beyond the polarization of “appropriate” and “inappropriate” service use. A deeper analysis of sense-m aking might shift the focus of attention and allow us to intervene to reshape understandings before this point
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