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- Title
Is it a matter of urgency? A survey of assessments by walk-in patients and doctors of the urgency level of their encounters at a general emergency outpatient clinic in Oslo, Norway.
- Authors
Ruud, Sven Eirik; Hjortdahl, Per; Natvig, Bård
- Abstract
<bold>Background: </bold>Emergency room (ER) use is increasing in several countries. Variability in the proportion of non-urgent ER visits was found to range from 5 to 90 % (median 32 %). Non-urgent emergency visits are considered an inappropriate and inefficient use of the health-care system because they may lead to higher expenses, crowding, treatment delays, and loss of continuity of health care provided by a general practitioner. Urgency levels of doctor-walk-in patient encounters were assessed based on their region of origin in a diverse Norwegian population.<bold>Methods: </bold>An anonymous, multilingual questionnaire was distributed to all walk-in patients at a general emergency outpatient clinic in Oslo during two weeks in September 2009. We analysed demographic data, patient-doctor assessments of the level of urgency, and the results of the consultation. We used descriptive statistics to obtain frequencies with 95 % confidence interval (CI) for assessed levels of urgency and outcomes. Concordance between the patients' and doctors' assessments was analysed using a Kendall tau-b test. We used binary logistic regression modelling to quantify associations of explanatory variables and outcomes according to urgency level assessments.<bold>Results: </bold>The analysis included 1821 walk-in patients. Twenty-four per cent of the patients considered their emergency consultation to be non-urgent, while the doctors considered 64 % of encounters to be non-urgent. The concordance between the assessments by the patient and by their doctor was positive but low, with a Kendall tau-b coefficient of 0.202 (p < 0.001). Adjusted logistic regression analysis showed that patients from Eastern Europe (odds ratio (OR) = 3.04; 95 % CI 1.60-5.78), Asia and Turkey (OR = 4.08; 95 % CI 2.43-6.84), and Africa (OR = 8.47; 95 % CI 3.87-18.5) reported significantly higher urgency levels compared with Norwegians. The doctors reported no significant difference in assessment of urgency based on the patient's region of origin, except for Africans (OR = 0.64; 95 % CI 0.43-0.96).<bold>Conclusion: </bold>This study reveals discrepancies between assessments by walk-in patients and doctors of the urgency level of their encounters at a general emergency clinic. The patients' self-assessed perception of the urgency level was related to their region of origin.
- Subjects
NORWAY; HOSPITAL emergency services; EMERGENCY medicine; PRIMARY care; GENERAL practitioners; IMMIGRANTS; MEDICAL emergencies; CLINICS; PSYCHOLOGY of immigrants; PATIENT psychology; PSYCHOLOGY of physicians; QUESTIONNAIRES; LOGISTIC regression analysis; SOCIOECONOMIC factors; PSYCHOLOGY
- Publication
BMC Emergency Medicine, 2016, Vol 16, p1
- ISSN
1471-227X
- Publication type
journal article
- DOI
10.1186/s12873-016-0086-1