Unscheduled care, what match between demand and supply of care? A qualitative study.

Frederic Chevallier, Alain Mercier, Yannick Ruelle

Keywords: Ambulatory care ; Walk-in care ;health services accessibility ; Health care team ; Relations interprofessionnelles ; Needs assessment

Background:

In Europe, the number of patients visiting hospital emergency departments has been increasing steadily for the past 20 years. In France, only 46% of requests for unscheduled care require treatment in hospital emergencies. The literature suggests a mismatch between primary care supply and patient demand. Little data is available on the opinions of users, and whether these opinions are in line with those of carers.

Research questions:

The objective of this work was to understand the match between the demand for unscheduled care and the supply of care based on an analysis of the experience of users and health professionals at the territorial level.

Method:

A qualitative study by semi-directed interviews collected the experiences and opinions of users and health professionals.

Results:

30 users, 22 doctors and 6 nurses were interviewed. The definition of unscheduled care was not consensual. Users integrated administrative demands, while carers did not. The care system was perceived to be overloaded and placed the responsibility for determining the urgency degree on the user without any reference point. Organisational problems contributed to self-censorship patterns. Doctors did not integrate these notions and emphasised the notion of delay (2-5 days) to get an appointment. For the doctors, the presence of dedicated time committed the professional to receiving unscheduled care and limited the stress of managing it. The group practice was favoured by the carers (quality of life) and by the users (flexibility of solutions). Triage was carried out by the secretaries, who did not feel legitimate to do so, which was a source of stress. Some facilities had the sorting done by a nurse on medical criteria.

Conclusions:

Users hesitated between not consulting and going to the emergency room and felt powerless to make decisions adapted to their needs. They asked for a dedicated comprehensive care system with a capacity for reassurance and referral.

Points for discussion:

- In a context of decreasing health care supply and increasing demand, how can we give users the tools to better determine the degree of urgency and to properly direct them towards the health care system adapted to the situation?

What role should users be given in the governance of this system? What place should be given to non-medical carers?

What would be the right indicators to pilot this system at the local level?

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