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Why do patients seek primary medical care in emergency departments? An ethnographic exploration of access to general practice

MacKichan, Fiona; Brangan, Emer; Wye, Lesley; Checkland, Kath; Lasserson, Daniel; Huntley, Alyson; Morris, Richard; Tammes, Peter; Salisbury, Chris; Purdy, Sarah

Authors

Fiona MacKichan

Lesley Wye

Kath Checkland

Daniel Lasserson

Alyson Huntley

Richard Morris

Peter Tammes

Chris Salisbury

Sarah Purdy



Abstract

Objectives: To describe how processes of primary care access influence decisions to seek help at the emergency department (ED).Design: Ethnographic case study combining non-participant observation, informal and formal interviewing.Setting: Six general practitioner (GP) practices located in three commissioning organisations in England.Participants and methods: Reception areas at each practice were observed over the course of a working week (73 hours in total). Practice documents were collected and clinical and non-clinical staff were interviewed (n=19). Patients with recent ED use, or a carer if aged 16 and under, were interviewed (n=29).Results: Past experience of accessing GP care recursively informed patient decisions about where to seek urgent care, and difficulties with access were implicit in patient accounts of ED use. GP practices had complicated, changeable systems for appointments. This made navigating appointment booking difficult for patients and reception staff, and engendered a mistrust of the system. Increasingly, the telephone was the instrument of demand management, but there were unintended consequences for access. Some patient groups, such as those with English as an additional language, were particularly disadvantaged, and the varying patient and staff semantic of words like ‘urgent’ and ‘emergency’ was exacerbated during telephone interactions. Poor integration between in-hours and out-of-hours care and patient perceptions of the quality of care accessible at their GP practice also informed ED use.Conclusions: This study provides important insight into the implicit role of primary care access on the use of ED. Discourses around ‘inappropriate’ patient demand neglect to recognise that decisions about where to seek urgent care are based on experiential knowledge. Simply speeding up access to primary care or increasing its volume is unlikely to alleviate rising ED use. Systems for accessing care need to be transparent, perceptibly fair and appropriate to the needs of diverse patient groups.

Citation

MacKichan, F., Brangan, E., Wye, L., Checkland, K., Lasserson, D., Huntley, A., …Purdy, S. (2017). Why do patients seek primary medical care in emergency departments? An ethnographic exploration of access to general practice. BMJ Open, 7(4), https://doi.org/10.1136/bmjopen-2016-013816

Journal Article Type Article
Acceptance Date Mar 13, 2019
Online Publication Date May 4, 2017
Publication Date May 4, 2017
Deposit Date Sep 26, 2019
Publicly Available Date Mar 28, 2024
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 7
Issue 4
DOI https://doi.org/10.1136/bmjopen-2016-013816
Public URL https://uwe-repository.worktribe.com/output/3241112

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Licence
http://creativecommons.org/licenses/by-nc/4.0/

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http://creativecommons.org/licenses/by-nc/4.0/

Copyright Statement
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.




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