title: Low-acuity presentations to the emergency department in Canada: exploring the alternative attempts to avoid presentation.
abstract: OBJECTIVE
  ED visits have been rising year on year worldwide. It has been suggested that some of these visits could be avoided if low-acuity patients had better primary care access. This study explored patients' efforts to avoid ED presentation and alternative care sought prior to presentation.
  
  
  METHODS
  Consecutive adult patients presenting to three urban EDs in Edmonton, Canada, completed a questionnaire collecting demographics, actions attempted to avoid presentation and reasons for presentation. Survey data were cross-referenced to a minimal patient dataset containing ED and demographic information.
  
  
  RESULTS
  A total of 1402 patients (66.5%) completed the survey. Although 89.3% of the patients felt that the ED was their best care option, the majority of patients (60.1%) sought alternative care or advice prior to presentation. Men, individuals who presented with injury only, and individuals with less than a high school education were all less likely to seek alternative care. Alternative care actions included visiting a physician (54.1%) or an alternative healthcare professional (eg, chiropractor, physiotherapist, etc; 21.2%), calling physician offices (47%) or the regional health information line (13%). Of those who called their physicians, the majority received advice to present to the ED (67.5%).
  
  
  CONCLUSIONS
  Most low-acuity patients attempt to avoid ED presentation by seeking alternative care. This analysis identifies groups of individuals in the study region who are less likely to seek alternative care first and may benefit from targeted interventions/education. Other regions may wish to complete a similar profile to determine which patients are less likely to seek alternative care first.
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Lynette D
authors.initials: LD
authors.lastname: Krebs
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Kirkland
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Chetram
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Taylor
authors.initials: T
authors.lastname: Nikel
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Britt
authors.initials: B
authors.lastname: Voaklander
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Davidson
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Bryn
authors.initials: B
authors.lastname: Holroyd
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.|School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Cristina
authors.initials: C
authors.lastname: Villa-Roel
authors.affiliation: Departments of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.|School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Katelynn
authors.initials: K
authors.lastname: Crick
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Couperthwaite
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Alexiu
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Garnet
authors.initials: G
authors.lastname: Cummings
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.|School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D002755:Choice Behavior; D003441:Crowding; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008297:Male; D000069342:Medical Overuse / Q000517:prevention & control*; D008875:Middle Aged; D062072:Patient Acuity; D010465:Perception; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014218:Triage / Q000379:methods / Q000706:statistics & numerical data
keywords: access to care; emergency department