Understanding young adults' reasons for seeking 'clinically unnecessary' urgent and emergency care: A qualitative interview study.

Jaqui Long,Lindsey Bishop‐Edwards,Emma Knowles,Alicia O’Cathain

doi:10.1111/hex.13301

Abstract

BackgroundStudies have identified young adults as more likely to use emergency departments for ‘clinically unnecessary’ problems, with limited similar evidence for emergency ambulance use. Media portrayals depict young adults as motivated by ‘convenience’, but little research has explored the reasons for their help‐seeking behaviour.MethodsQualitative interviews with 16 young adults (18‐30) considered by clinicians to have made unnecessary use of emergency ambulance, emergency department or an urgent GP appointment. Data analysis was informed by interpretive phenomenological analysis.FindingsA number of interrelated factors contributed to participants’ decisions. They were anxious about the seriousness of their symptoms, sometimes exacerbated by reduced coping capacity due to poor mental health or life stresses. They looked to others to facilitate their decision making, who sometimes encouraged urgent contact. They wanted to avoid impact on existing day‐to‐day commitments including work or study. They had strong views about different health services, sometimes based on frustration with lack of resolution of on‐going health problems. Convenience was not identified as a significant factor, although some actions could be interpreted in this light if the context was not considered.ConclusionsYoung adults make ‘clinically unnecessary’ use of urgent and emergency care for more than convenience. Their decisions need to be understood in relation to the complexity of their experience, including lack of confidence in making health‐related decisions, lowered coping capacity and concern to maintain normal daily life.

Highlights

Studies have identified young adults as more likely to use emergency departments for ‘clinically unnecessary’ problems, with limited similar evidence for emergency ambulance use
We focused some of this research on three groups perceived to be more likely to be clinically unnecessary users: young adults, parents of young children and those living in areas of deprivation
The study included a realist review of qualitative literature,[25] through which we developed ten ‘programme theories’ (PTs) to explain help-seeking decisions (Figure 1)

Summary

Introduction

Studies have identified young adults as more likely to use emergency departments for ‘clinically unnecessary’ problems, with limited similar evidence for emergency ambulance use. Findings: A number of interrelated factors contributed to participants’ decisions They were anxious about the seriousness of their symptoms, sometimes exacerbated by reduced coping capacity due to poor mental health or life stresses. They looked to others to facilitate their decision making, who sometimes encouraged urgent contact. Conclusions: Young adults make ‘clinically unnecessary’ use of urgent and emergency care for more than convenience Their decisions need to be understood in relation to the complexity of their experience, including lack of confidence in making healthrelated decisions, lowered coping capacity and concern to maintain normal daily life. Urgent and emergency care services in many countries are under increasing pressure due to growing demand that has not been matched by an equivalent expansion in resources.[1,2] In the UK, challenges are acute for the emergency ambulance service, emergency departments (EDs) and urgent same-day general practice (GP) appointments.[3,4,5,6] A particular concern is that some demand may be due to patients using services for problems that do not need such a high-acuity service or could be managed through self-care.[7,8] Such demand is described as using services for non-urgent, medically unnecessary or low acuity problems, or as ‘inappropriate use’.9-12 In this article, we use the term ‘clinically unnecessary’, recognizing that these definitions or judgements are from clinicians’ perspective, and that patients’ decisions may be driven by other, non-clinical, considerations

Objectives

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Discussion

Conclusion