Engaging the public in healthcare decision-making: results from a Citizens' Jury on emergency care services.
BACKGROUND
Policies addressing ED crowding have failed to incorporate the public's perspectives; engaging the public in such policies is needed.


OBJECTIVE
This study aimed at determining the public's recommendations related to alternative models of care intended to reduce crowding, optimising access to and provision of emergency care.


METHODS
A Citizens' Jury was convened in Queensland, Australia, to consider priority setting and resource allocation to address ED crowding. Twenty-two jurors were recruited from the electoral roll, who were interested and available to attend the jury from 15 to 17 June 2012. Juror feedback was collected via a survey immediately following the end of the jury.


RESULTS
The jury considered that all patients attending the ED should be assessed with a minority of cases diverted for assistance elsewhere. Jurors strongly supported enabling ambulance staff to treat patients in their homes without transporting them to the ED, and allowing non-medical staff to treat some patients without seeing a doctor. Jurors supported (in principle) patient choice over aspects of their treatment (when, where and type of health professional) with some support for patients paying towards treatment but unanimous opposition for patients paying to be prioritised. Most of the jurors were satisfied with their experience of the Citizens' Jury process, but some jurors perceived the time allocated for deliberations as insufficient.


CONCLUSIONS
These findings suggest that the general public may be open to flexible models of emergency care. The jury provided clear recommendations for direct public input to guide health policy to tackle ED crowding.
Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia.
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Scuffham
Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia.
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Moretto
Centre of National Research on Disability and Rehabilitation, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia.
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Krinks
Urban Research Program, Griffith School of Environment, Griffith University, Southport, Queensland, Australia.
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Burton
Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia.|School of Pharmacy, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Queensland, Australia.
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Whitty
Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
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Wilson
School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
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Fitzgerald
Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King's College London, London, UK.
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Littlejohns
Centre of National Research on Disability and Rehabilitation, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia.
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Kendall
D000293:Adolescent; D000328:Adult; D003441:Crowding; D003657:Decision Making; D004632:Emergency Medical Services / Q000592:standards* / Q000600:supply & distribution; D004638:Emergency Treatment / Q000379:methods* / Q000592:standards; D005260:Female; D006292:Health Priorities / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D011641:Public Relations / Q000639:trends*; D011793:Queensland; D011795:Surveys and Questionnaires
crowding; emergency department management