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BMC Health Services Research
Published in: BMC Health Services Research 1/2022

Open Access 01-12-2022 | Care | Research

Emergency department consultations for respiratory symptoms revisited: exploratory investigation of longitudinal trends in patients’ perspective on care, health care utilization, and general and mental health, from a multicenter study in Berlin, Germany

Authors: Felix Holzinger, Sarah Oslislo, Lisa Kümpel, Rebecca Resendiz Cantu, Martin Möckel, Christoph Heintze

Published in: BMC Health Services Research | Issue 1/2022

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Abstract

Background

Only few studies of emergency department (ED) consulters include a longitudinal investigation. The EMACROSS study had surveyed 472 respiratory patients in eight inner-city EDs in Berlin in 2017/2018 for demographic, medical and consultation-related characteristics. This paper presents the results of a follow-up survey at a median of 95 days post-discharge. We aimed to explore the post hoc assessment of ED care and identify potential longitudinal trends.

Methods

The follow-up survey included items on satisfaction with care received, benefit from the ED visit, potential alternative care, health care utilization, mental and general health, and general life satisfaction. Univariable between-subject and within-subject statistical comparisons were conducted. Logistic regression was performed for multivariable investigations of determinants of dropout and of retrospectively rating the ED visit as beneficial.

Results

Follow-up data was available for 329 patients. Participants of lower education status, migrants, and tourists were more likely to drop out. Having a general practitioner (GP), multimorbidity, and higher general life satisfaction were determinants of response. Retrospective satisfaction ratings were high with no marked longitudinal changes and waiting times as the most frequent reason for dissatisfaction. Retrospective assessment of the visit as beneficial was positively associated with male sex, diagnoses of pneumonia and respiratory failure, and self-referral. Concerning primary care as a viable alternative, judgment at the time of the ED visit and at follow-up did not differ significantly. Health care utilization post-discharge increased for GPs and pulmonologists. Self-reported general health and PHQ-4 anxiety scores were significantly improved at follow-up, while general life satisfaction for the overall sample was unchanged.

Conclusions

Most patients retrospectively assess the ED visit as satisfactory and beneficial. Possible sex differences in perception of care and its outcomes should be further investigated. Conceivable efforts at diversion of ED utilizers to primary care should consider patients’ views regarding acceptable alternatives, which appear relatively independent of situational factors. Representativeness of results is restricted by the study focus on respiratory symptoms, the limited sample size, and the attrition rate.

Trial registration

German Clinical Trials Register (DRKS00011930); date: 2017/04/25.
Appendix
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Literature
1.
Pines JM, Hilton JA, Weber EJ, Alkemade AJ, Al Shabanah H, Anderson PD, et al. International perspectives on emergency department crowding. Acad Emerg Med. 2011;18(12):1358–70.PubMedCrossRef
2.
Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: a systematic review of causes, consequences and solutions. PLoS One. 2018;13(8):e0203316.PubMedPubMedCentralCrossRef
3.
Lega F, Mengoni A. Why non-urgent patients choose emergency over primary care services? Empirical evidence and managerial implications. Health Policy. 2008;88(2–3):326–38.PubMedCrossRef
4.
Penson R, Coleman P, Mason S, Nicholl J. Why do patients with minor or moderate conditions that could be managed in other settings attend the emergency department? Emerg Med J. 2012;29(6):487–91.PubMedCrossRef
5.
Uscher-Pines L, Pines J, Kellermann A, Gillen E, Mehrotra A. Emergency department visits for nonurgent conditions: systematic literature review. Am J Manag Care. 2013;19(1):47–59.PubMedPubMedCentral
6.
Schmiedhofer M, Mockel M, Slagman A, Frick J, Ruhla S, Searle J. Patient motives behind low-acuity visits to the emergency department in Germany: a qualitative study comparing urban and rural sites. BMJ Open. 2016;6(11):e013323.PubMedPubMedCentralCrossRef
7.
Cowling TE, Cecil EV, Soljak MA, Lee JT, Millett C, Majeed A, et al. Access to primary care and visits to emergency departments in England: a cross-sectional, population-based study. PLoS One. 2013;8(6):e66699.PubMedPubMedCentralCrossRef
8.
Durand A-C, Palazzolo S, Tanti-Hardouin N, Gerbeaux P, Sambuc R, Gentile S. Nonurgent patients in emergency departments: rational or irresponsible consumers? Perceptions of professionals and patients. BMC Res Notes. 2012;5:525.PubMedPubMedCentralCrossRef
9.
Holzinger F, Oslislo S, Möckel M, Schenk L, Pigorsch M, Heintze C. Self-referred walk-in patients in the emergency department - who and why? Consultation determinants in a multicenter study of respiratory patients in Berlin, Germany. BMC Health Serv Res. 2020;20(1):848.PubMedPubMedCentralCrossRef
10.
Holzinger F, Oslislo S, Resendiz Cantu R, Möckel M, Heintze C. Diverting less urgent utilizers of emergency medical services to primary care: is it feasible? Patient and morbidity characteristics from a cross-sectional multicenter study of self-referring respiratory emergency department consulters. BMC Res Notes. 2021;14(1):113.PubMedPubMedCentralCrossRef
11.
Brown CJ, Kennedy RE, Lo AX, Williams CP, Sawyer P. Impact of emergency department visits and hospitalization on mobility among community-dwelling older adults. Am J Med. 2016;129(10):1124.e9–e15.CrossRef
12.
Rosychuk RJ, Holroyd BR, Zhang X, Rowe BH, Graham MM. Sex differences in outcomes after discharge from the emergency department for atrial fibrillation/flutter. Can J Cardiol. 2017;33(6):806–13.PubMedCrossRef
13.
Quintana JM, Esteban C, Garcia-Gutierrez S, Aguirre U, Gonzalez N, Lafuente I, et al. Predictors of hospital admission two months after emergency department evaluation of COPD exacerbation. Respiration. 2014;88(4):298–306.PubMedCrossRef
14.
Lin MP, Burke RC, Orav EJ, Friend TH, Burke LG. Ambulatory follow-up and outcomes among Medicare beneficiaries after emergency department discharge. JAMA Netw Open. 2020;3(10):e2019878.PubMedPubMedCentralCrossRef
15.
Kraaijvanger N, Rijpsma D, Willink L, Lucassen P, van Leeuwen H, Edwards M. Why patients self-refer to the emergency department: a qualitative interview study. J Eval Clin Pract. 2017;23(3):593–8.PubMedCrossRef
16.
Schmiedhofer M, Inhoff T, Krobisch V, Schenk L, Rose M, Holzinger F, et al. EMANet: a regional network for health services research in emergency and acute medicine. Z Evid Fortbild Qual Gesundhwes. 2018;135-136:81–8.PubMedCrossRef
17.
Oslislo S, Heintze C, Möckel M, Schenk L, Holzinger F. What role does the GP play for emergency department utilizers? A qualitative exploration of respiratory patients’ perspectives in Berlin, Germany. BMC Fam Pract. 2020;21(1):154.PubMedPubMedCentralCrossRef
18.
Kroenke K, Spitzer RL, Williams JB, Lowe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics. 2009;50(6):613–21.PubMed
19.
Beierlein C, Kovaleva A, László Z, et al. Eine Single-Item-Skala zur Erfassung der Allgemeinen Lebenszufriedenheit: Die Kurzskala Lebenszufriedenheit-1 (L-1). Mannheim: Leibniz-Institute für Sozialwissenschaften (Gesis); 2014.
20.
Rattay P, Butschalowsky H, Rommel A, Prutz F, Jordan S, Nowossadeck E, et al. Utilization of outpatient and inpatient health services in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56(5–6):832–44.PubMedCrossRef
21.
Palli SR, Xie B, Chastek B, Elliott CA, Bengtson LGS. Comparison of COPD health care utilization and associated costs across patients treated with LAMA+LABA fixed-dose therapies. J Manag Care Spec Pharm. 2021;27(7):810–24.PubMed
22.
23.
24.
25.
Hudak PL, McKeever P, Wright JG. The metaphor of patients as customers: implications for measuring satisfaction. J Clin Epidemiol. 2003;56(2):103–8.PubMedCrossRef
26.
Pitrou I, Lecourt AC, Bailly L, Brousse B, Dauchet L, Ladner J. Waiting time and assessment of patient satisfaction in a large reference emergency department: a prospective cohort study, France. Eur J Emerg Med. 2009;16(4):177–82.PubMedCrossRef
27.
Soares AM, Farhangmehr M. Understanding patient satisfaction in a hospital emergency department. Int Rev Public Nonprofit Mark. 2015;12(1):1–15.CrossRef
28.
Nerney MP, Chin MH, Jin L, Karrison TG, Walter J, Mulliken R, et al. Factors associated with older patients’ satisfaction with care in an inner-city emergency department. Ann Emerg Med. 2001;38(2):140–5.PubMedCrossRef
29.
Schwab RA. Emergency department customer satisfaction: the point of view paradox. Ann Emerg Med. 2000;35(5):499–501.PubMedCrossRef
30.
Son H, Yom YH. Factors influencing satisfaction with emergency department medical service: patients’ and their companions’ perspectives. Jpn J Nurs Sci. 2017;14(1):27–37.PubMedCrossRef
31.
Abolfotouh M, Al-Assiri M, Alshahrani R, Almutairi Z, Hijazi R, Alaskar A. Predictors of patient satisfaction in an emergency care centre in central Saudi Arabia: a prospective study. Emerg Med J. 2016;34:1–7.
32.
Natesan P, Hadid D, Harb YA, Hitti E. Comparing patients and families perceptions of satisfaction and predictors of overall satisfaction in the emergency department. PLoS One. 2019;14(8):e0221087.PubMedPubMedCentralCrossRef
33.
Goldwag R, Berg A, Yuval D, Benbassat J. Predictors of patient dissatisfaction with emergency care. Isr Med Assoc J. 2002;4(8):603–6.PubMed
34.
Singh AK, Cydulka RK, Stahmer SA, Woodruff PG, Camargo CA Jr, Investigators ftMARC. Sex differences among adults presenting to the emergency department with acute asthma. Arch Int Med. 1999;159(11):1237–43.CrossRef
35.
van Wijk CMTG, Kolk AM. Sex differences in physical symptoms: the contribution of symptom perception theory. Soc Sci Med. 1997;45(2):231–46.PubMedCrossRef
36.
Patel R, Biros MH, Moore J, Miner JR. Gender differences in patient-described pain, stress, and anxiety among patients undergoing treatment for painful conditions in the emergency department. Acad Emerg Med. 2014;21(12):1478–84.PubMedCrossRef
37.
Gargano JW, Wehner S, Reeves MJ. Do presenting symptoms explain sex differences in emergency department delays among patients with acute stroke? Stroke. 2009;40(4):1114–20.PubMedCrossRef
38.
D’Onofrio G, Safdar B, Lichtman JH, Strait KM, Dreyer RP, Geda M, et al. Sex differences in reperfusion in young patients with ST-segment–elevation myocardial infarction. Circulation. 2015;131(15):1324–32.PubMedPubMedCentralCrossRef
39.
40.
Delgado A, Saletti-Cuesta L, López-Fernández LA, Gil-Garrido N, Luna del Castillo JD. Gender inequalities in COPD decision-making in primary care. Respir Med. 2016;114:91–6.PubMedCrossRef
41.
O’Keeffe C, Mason S, Jacques R, Nicholl J. Characterising non-urgent users of the emergency department (ED): a retrospective analysis of routine ED data. PLoS One. 2018;13(2):e0192855.PubMedPubMedCentralCrossRef
42.
Gill JM, Riley AW. Nonurgent use of hospital emergency departments: urgency from the patient’s perspective. J Fam Pract. 1996;42(5):491–6.PubMed
43.
Morgans A, Burgess SJ. What is a health emergency? The difference in definition and understanding between patients and health professionals. Austral Health Rev. 2011;35(3):284–9.CrossRef
44.
Oslislo S, Kümpel L, Cantu RR, Möckel M, Heintze C, Holzinger F. Bin ich ein Notfall? Notfallempfinden und Entscheidungskompetenz in akuten Situationen: eine qualitative Erhebung bei Notaufnahmepatient*innen. Z Evid Fortbild Qual Gesundhwes. 2021;165:43–50.PubMedCrossRef
45.
Stempel DA, Roberts CS, Stanford RH. Treatment patterns in the months prior to and after asthma-related emergency department visit. Chest. 2004;126(1):75–80.PubMedCrossRef
46.
Lowthian J, Straney LD, Brand CA, Barker AL, Smit PV, Newnham H, et al. Unplanned early return to the emergency department by older patients: the safe elderly emergency department discharge (SEED) project. Age Ageing. 2016;45(2):255–61.PubMedCrossRef
47.
Bernstein E. Repeat visits by elder emergency department patients: sentinel events. Acad Emerg Med. 1997;4(6):538–9.PubMedCrossRef
48.
Bakal JA, McAlister FA, Liu W, Ezekowitz JA. Heart failure re-admission: measuring the ever shortening gap between repeat heart failure hospitalizations. PLoS One. 2014;9(9):e106494.PubMedPubMedCentralCrossRef
49.
Schneider A, Riedlinger D, Pigorsch M, Holzinger F, Deutschbein J, Keil T, et al. Self-reported health and life satisfaction in older emergency department patients: sociodemographic, disease-related and care-specific associated factors. BMC Public Health. 2021;21(1):1440.PubMedPubMedCentralCrossRef
50.
Janssen B, Szende A. Population norms for the EQ-5D. In: Szende A, Janssen B, Cabases J, editors. Self-reported population health: an international perspective based on EQ-5D. Dordrecht: Springer; 2014.
51.
Baggio S, Iglesias K, Hugli O, Burnand B, Ruggeri O, Wasserfallen J-B, et al. Associations between perceived discrimination and health status among frequent emergency department users. Eur J Emerg Med. 2017;24(2):136–41.PubMedCrossRef
52.
Koivunen M, Harju S, Kauko T, Välimäki M. Alcohol risk drinking, quality of life and health state among patients treated at the sobering unit in the emergency department – one year follow-up study. Int Emerg Nurs. 2017;31:22–9.PubMedCrossRef
53.
Faessler L, Brodbeck J, Schuetz P, Haubitz S, Mueller B, Perrig-Chiello P. Medical patients’ affective well-being after emergency department admission: the role of personal and social resources and health-related variables. PLoS One. 2019;14(3):e0212900.PubMedPubMedCentralCrossRef
54.
Figura A, Kuhlmann SL, Rose M, Slagman A, Schenk L, Möckel M. Mental health conditions in older multimorbid patients presenting to the emergency department for acute cardiac symptoms: cross-sectional findings from the EMASPOT study. Acad Emerg Med. https://​doi.​org/​10.​1111/​acem.​14349 Online ahead of print.
55.
Barbic S, MacEwan WG, Leon A, Chau S, Barbic D. LO60: validation of the PHQ-9 as a screen for depression in the emergency department. CJEM. 2017;19(S1):S48.CrossRef
56.
Currow DC, Chang S, Reddel HK, Kochovska S, Ferreira D, Kinchin I, et al. Breathlessness, anxiety, depression, and function–the BAD-F study: a cross-sectional and population prevalence study in adults. J Pain Symptom Manag. 2020;59(2):197–205.e2.CrossRef
57.
Whiteford HA, Harris MG, McKeon G, Baxter A, Pennell C, Barendregt JJ, et al. Estimating remission from untreated major depression: a systematic review and meta-analysis. Psychol Med. 2012;43(8):1569–85.PubMedCrossRef
58.
Faessler L, Kutz A, Haubitz S, Mueller B, Perrig-Chiello P, Schuetz P. Psychological distress in medical patients 30 days following an emergency department admission: results from a prospective, observational study. BMC Emerg Med. 2016;16(1):33.PubMedPubMedCentralCrossRef
59.
Halpin D, Hyland M, Blake S, Seamark C, Pinnuck M, Ward D, et al. Understanding fear and anxiety in patients at the time of an exacerbation of chronic obstructive pulmonary disease: a qualitative study. JRSM Open. 2015;6(12):2054270415614543.PubMedPubMedCentralCrossRef
60.
Chatfield MD, Brayne CE, Matthews FE. A systematic literature review of attrition between waves in longitudinal studies in the elderly shows a consistent pattern of dropout between differing studies. J Clin Epidemiol. 2005;58(1):13–9.PubMedCrossRef
61.
Fan W, Yan Z. Factors affecting response rates of the web survey: a systematic review. Comput Hum Behav. 2010;26(2):132–9.CrossRef
62.
Canivet C, Nilsson A, Björk J, Moghaddassi M, Östergren P-O. Assessment of selection bias due to dropouts in the follow-up of the Scania Public Health Cohort. Scand J Public Health. 2020;49(4):457–64.PubMedPubMedCentralCrossRef
63.
Eisner NL, Murray AL, Eisner M, Ribeaud D. A practical guide to the analysis of non-response and attrition in longitudinal research using a real data example. Int J Behav Dev. 2018;43(1):24–34.CrossRef
64.
Gustavson K, von Soest T, Karevold E, Røysamb E. Attrition and generalizability in longitudinal studies: findings from a 15-year population-based study and a Monte Carlo simulation study. BMC Public Health. 2012;12(1):918.PubMedPubMedCentralCrossRef
65.
Tin Tin S, Woodward A, Ameratunga S. Estimating bias from loss to follow-up in a prospective cohort study of bicycle crash injuries. Inj Prev. 2014;20(5):322–9.PubMedCrossRef
66.
Maehler DB, Martin S, Rammstedt B. Coverage of the migrant population in large-scale assessment surveys. Experiences from PIAAC in Germany. Large-Scale Assess Educ. 2017;5(1):9.CrossRef
67.
Hofman SE, Lucke JA, Heim N, de Gelder J, Fogteloo AJ, Heringhaus C, et al. Prediction of 90-day mortality in older patients after discharge from an emergency department: a retrospective follow-up study. BMC Emerg Med. 2016;16(1):26.PubMedPubMedCentralCrossRef
68.
Genao L, Durheim MT. Early and long-term outcomes of older adults after acute care encounters for chronic obstructive pulmonary disease exacerbation. Ann Am Thorac Soc. 2015;12(12):1805–12.PubMedPubMedCentralCrossRef
69.
Öhlén J, Jakobsson Ung E, Bergh I, Odén A, Gaston Johansson F. Utilization of health-care services at the end-of-life. Health Policy. 2007;82(3):276–87.PubMedCrossRef
70.
Hall AG, Schumacher JR, Brumback B, Harman JS, Lutz BJ, Hendry P, et al. Health-related quality of life among older patients following an emergency department visit and emergency department-to-home coaching intervention: a randomized controlled trial. Int J Care Coord. 2017;20(4):162–70.
71.
Nicks BA, Shah MN, Adler DH, Bastani A, Baugh CW, Caterino JM, et al. Minimizing attrition for multisite emergency care research. Acad Emerg Med. 2017;24(4):458–66.PubMedPubMedCentralCrossRef
72.
Osler M, Kriegbaum M, Christensen U, Lund R, Nybo Andersen AM. Loss to follow up did not bias associations between early life factors and adult depression. J Clin Epidemiol. 2008;61(9):958–63.PubMedCrossRef
73.
Kempen GI, van Sonderen E. Psychological attributes and changes in disability among low-functioning older persons: does attrition affect the outcomes? J Clin Epidemiol. 2002;55(3):224–9.PubMedCrossRef
74.
Wolke D, Waylen A, Samara M, Steer C, Goodman R, Ford T, et al. Selective drop-out in longitudinal studies and non-biased prediction of behaviour disorders. Br J Psychiatry. 2018;195(3):249–56.CrossRef
75.
Hunger M, Schwarzkopf L, Heier M, Peters A, Holle R. Official statistics and claims data records indicate non-response and recall bias within survey-based estimates of health care utilization in the older population. BMC Health Serv Res. 2013;13:1.PubMedPubMedCentralCrossRef
76.
Short ME, Goetzel RZ, Pei X, Tabrizi MJ, Ozminkowski RJ, Gibson TB, et al. How accurate are self-reports? Analysis of self-reported health care utilization and absence when compared with administrative data. J Occup Environ Med. 2009;51(7):786–96.PubMedPubMedCentralCrossRef
77.
78.
Trout A, Magnusson AR, Hedges JR. Patient satisfaction investigations and the emergency department: what does the literature say? Acad Emerg Med. 2000;7(6):695–709.PubMedCrossRef
79.
Voutilainen A, Pitkäaho T, Kvist T, Vehviläinen-Julkunen K. How to ask about patient satisfaction? The visual analogue scale is less vulnerable to confounding factors and ceiling effect than a symmetric Likert scale. J Adv Nurs. 2016;72(4):946–57.PubMedCrossRef
80.
Kristensson J, Ekwall A. Psychometric properties of the consumer emergency care satisfaction scale. J Nurs Care Qual. 2008;23:277–82.PubMedCrossRef
81.
Vaillancourt S, Cullen JD, Dainty KN, Inrig T, Laupacis A, Linton D, et al. PROM-ED: development and testing of a patient-reported outcome measure for emergency department patients who are discharged home. Ann Emerg Med. 2020;76(2):219–29.PubMedCrossRef
82.
Vaillancourt S, Seaton MB, Schull MJ, Cheng AHY, Beaton DE, Laupacis A, et al. Patients’ perspectives on outcomes of care after discharge from the emergency department: a qualitative study. Ann Emerg Med. 2017;70(5):648–58.e2.PubMedCrossRef
83.
Metadata
Title
Emergency department consultations for respiratory symptoms revisited: exploratory investigation of longitudinal trends in patients’ perspective on care, health care utilization, and general and mental health, from a multicenter study in Berlin, Germany
Authors
Felix Holzinger
Sarah Oslislo
Lisa Kümpel
Rebecca Resendiz Cantu
Martin Möckel
Christoph Heintze
Publication date
01-12-2022
Publisher
BioMed Central
Keyword
Care
Published in
BMC Health Services Research / Issue 1/2022
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-022-07591-5

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