Low-acuity presentations to the emergency department: Reasons for and access to other health care providers before presentation.

OBJECTIVE: To describe the demographic characteristics of patients who present to the emergency department (ED) for low-acuity issues and to explore their self-reported contact with other sources of primary health care before presenting to the ED. DESIGN: Survey distributed in the ED waiting room. SETTING: A high-volume ED in Vancouver, BC. PARTICIPANTS: A total of 232 respondents aged 18 years or older in the ED waiting room. MAIN OUTCOME MEASURES: Actions taken to seek health care for the current issue before presenting to the ED and predictors of first seeking nonurgent care. RESULTS: Of the 398 people approached, 232 (58.3%) people completed the survey. Exactly half (95% CI 43.6% to 56.4%) sought alternative care before presenting to the ED. Predictors for having sought alternative care included illness presentation and longer symptom duration, while injury presentation and work-related presentation were associated with not seeking alternative care. Most participants (162 patients, 87.6%) believed that the ED was the most appropriate place for them to receive care for their problem, while only 87 (45.3%) believed that an adjacent primary care clinic would be an acceptable alternative. CONCLUSION: Many patients do attempt to seek alternative care before presenting to the ED with low acuity issues. Most patients believe that the ED is the best place for them to receive care and are uncertain about using a primary care alternative. Further research is needed to explore barriers and motivators patients face in their decisions to seek care, as well as potential patient education methods to improve appropriate ED use.

How's Your Health at Home: Frail Homebound Patients Reported Health Experience and Outcomes.

We used a web-based mixed methods survey (HowsYourHealth - Frail) to explore the health of frail older (78% age 80 or older) adults enrolled in a home-based primary care program in Vancouver, Canada. Sixty per cent of eligible respondents participated, representing over one quarter (92/350, 26.2%) of all individuals receiving the service. Despite high levels of co-morbidity and functional dependence, 50 per cent rated their health as good, very good, or excellent. Adjusted odds ratios for positive self-rated health were 7.50, 95 per cent CI [1.09, 51.81] and 4.85, 95 per cent CI [1.02, 22.95] for absence of bothersome symptoms and being able to talk to family or friends respectively. Narrative responses to questions about end of life and living with illness are also described. Results suggest that greater focus on symptom management, and supporting social contact, may improve frail seniors' health.