Distances to emergency departments and non-urgent utilization of medical services: a systematic review.

ABSTRACT

BACKGROUND: The use of Emergency Departments (EDs) for non-urgent medical conditions is a global public health concern. OBJECTIVES: A systematic review, guided by a registered protocol (PROSPERO CRD42023398674), was conducted to interpret the association between distance as a measure of healthcare access and the utilization of EDs for non-urgent care in high- and middle-income countries. METHODS: The search was conducted on 22 August 2023 across five databases using controlled vocabulary and natural language keywords. Eligibility criteria included studies that examined non-urgent care, and featured concepts of emergency departments, non-urgent health services and distance, reported in English. Articles and abstracts where patients were transported by ambulance/paramedic services, referred/transferred from another hospital to an ED, or those that measured distance to an ED from another health facility were excluded. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework informed the quality of evidence. RESULTS: Fifteen articles met the inclusion criteria. All studies demonstrated satisfactory quality with regard to study design, conduct, analysis and presentation of results. Eight (53.3%) of the studies (1 paediatric, 4 all ages/adult, 3 ecological) found a moderate level of evidence of an inverse association between distance and ED visit volume or utilization for non-urgent medical conditions, while the remaining studies reported very low or low evidence. CONCLUSIONS: Half of the studies reported non-urgent ED use to be associated with shortest distance traveled or transportation time. This finding bears implications for healthcare policies aiming to reduce ED use for non-urgent care.

Main findings: Using the systematic review methodology, a qualitative synthesis of the prior literature showed moderate evidence of the negative role of distance on emergency departments use across middle- and high-income countries.Added knowledge This systematic review adds to the literature by providing evidence that clarifies prior inconsistent findings on the association between distance, a measure of healthcare access, and non-urgent emergency department utilization.Global health impact for policy and action Based on the main finding of negative role of distance, a three-tiered policy recommendation to reduce non-urgent use of emergency departments is provided that include 1) public health systems reforms, 2) patient education, and 3) improved access to primary care providers.