title: Nonurgent patients in emergency departments: rational or irresponsible consumers? Perceptions of professionals and patients.
abstract: BACKGROUND
  For several decades, overcrowding in emergency departments (EDs) has been intensifying due to the increased number of patients seeking care in EDs. Demand growth is partly due to misuse of EDs by patients who seek care for nonurgent problems. This study explores the reasons why people with nonurgent complaints choose to come to EDs, and how ED health professionals perceive the phenomenon of "nonurgency".
  
  
  RESULTS
  Semi-structured interviews were conducted in 10 EDs with 87 nonurgent patients and 34 health professionals. Interviews of patients revealed three themes: (1) fulfilled health care needs, (2) barriers to primary care providers (PCPs), and (3) convenience. Patients chose EDs as discerning health consumers: they preferred EDs because they had difficulties obtaining a rapid appointment. Access to technical facilities in EDs spares the patient from being overwhelmed with appointments with various specialists. Four themes were identified from the interviews of health professionals: (1) the problem of defining a nonurgent visit, (2) explanations for patients' use of EDs for nonurgent complaints, (3) consequences of nonurgent visits, and (4) solutions to counter this tendency.
  
  
  CONCLUSIONS
  Studies on the underlying reasons patients opt for the ED, as well as on their decision-making process, are lacking. The present study highlighted discrepancies between the perceptions of ED patients and those of health professionals, with a special focus on patient behaviour. To explain the use of ED, health professionals based themselves on the acuity and urgency of medical problems, while patients focused on rational reasons to initiate care in the ED (accessibility to health care resources, and the context in which the medical problem occurred). In spite of some limitations due to the slightly outdated nature of our data, as well as the difficulty of categorizing nonurgent situations, our findings show the importance of conducting a detailed analysis of the demand for health care. Understanding it is crucial, as it is the main determining factor in the utilization of health care resources, and provides promising insights into the phenomenon of ED usage increase. For reforms to be successful, the process of decision-making for unscheduled patients will have to be thoroughly investigated.
authors.affiliation: Laboratoire de Santé Publique, Faculté de Médecine, Equipe de recherche EA 3279 "Evaluation hospitalière-Mesure de la santé perçue", 27 boulevard Jean Moulin, 13385 Marseille cedex 5, France. anne-claire.durand@ap-hm.fr
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Durand
authors.forename: Sylvie
authors.initials: S
authors.lastname: Palazzolo
authors.forename: Nicolas
authors.initials: N
authors.lastname: Tanti-Hardouin
authors.forename: Patrick
authors.initials: P
authors.lastname: Gerbeaux
authors.forename: Roland
authors.initials: R
authors.lastname: Sambuc
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Gentile
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D004630:Emergencies / Q000145:classification / Q000523:psychology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006282:Health Personnel / Q000523:psychology; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000145:classification / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000145:classification / Q000523:psychology; D011320:Primary Health Care / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D055815:Young Adult