What role does the GP play for emergency department utilizers? A qualitative exploration of respiratory patients\u2019 perspectives in Berlin, Germany

Sarah Oslislo,Martin Möckel,Christoph Heintze,Liane Schenk,Felix Holzinger

doi:10.1186/s12875-020-01222-w

Abstract

BackgroundWhile motives for emergency department (ED) self-referrals have been investigated in a number of studies, the relevance of general practitioner (GP) care for these patients has not been comprehensively evaluated. Respiratory symptoms constitute an important utilization trigger in both EDs and in primary care. In this qualitative study, we aimed to explore the role of GP care for patients visiting EDs as outpatients for respiratory complaints and the relevance of the relationship between patient and GP in the decision making process leading up to an ED visit.MethodsQualitative descriptive study. Semi-structured, face-to-face interviews with a sample of 17 respiratory ED patients in Berlin, Germany. Interviews were recorded and transcribed verbatim. Qualitative content analysis was performed. The study was embedded into the EMACROSS (Emergency and Acute Care for Respiratory Diseases beyond Sectoral Separation) cohort of ED patients with respiratory symptoms, which is part of EMANet (Emergency and Acute Medicine Network for Health Care Research).ResultsThree patterns of GP utilization could be differentiated: long-term regular consulters, sporadic consulters and patients without GP. In sporadic consulters and patients without GP, an ambivalent or even aversive view of GP care was prevalent, with lack of confidence in GPs’ competence and a deficit in trust as seemingly relevant influencing factors. Regardless of utilization or relationship type, patients frequently made contact with a GP before visiting an ED.ConclusionsWith regard to respiratory symptoms, our qualitative data suggest a hypothesis of limited relevance of patients’ primary care utilization pattern and GP-patient relationship for ED consultation decisions.

Highlights

While motives for emergency department (ED) self-referrals have been investigated in a number of studies, the relevance of general practitioner (GP) care for these patients has not been comprehensively evaluated
To what extent was your GP / a GP involved in the decision making process that led to your ED visit?
Results in context In our sample of patients with respiratory complaints, we gained the impression that neither the general role of the GP in patients’ health care nor the individual doctorpatient relationship seemed to constitute a central factor in the decision making leading up to an ED consultation

Summary

Introduction

Respiratory symptoms constitute an important utilization trigger in both EDs and in primary care. In this qualitative study, we aimed to explore the role of GP care for patients visiting EDs as outpatients for respiratory complaints and the relevance of the relationship between patient and GP in the decision making process leading up to an ED visit. Health-related anxiety and the surmised availability of advanced diagnostics in the hospital setting have been discussed as important factors in the complex decision making process leading up to ED utilization, as well as a lack of connection to continuous primary care [3, 9, 10]. Why patients who are embedded in a functioning continuous care relationship with a GP might still frequently consult EDs and whether these patients’ utilization differs from patients without regular GP attachment remains unresolved. Choice of point of care is often left to the patient in absence of explicit rules or steering mechanisms

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Conclusion