Patient Perspectives on Accessing Acute Illness Care.

Area of Science:

• Gerontology
• Health Services Research
• Qualitative Research

Background:

• Older adults frequently use emergency departments (EDs) for conditions manageable by primary care providers (PCPs).
• Existing policies to alter ED use patterns in older adults have shown limited success.
• Understanding the decision-making process of older adults is crucial for effective healthcare system design.

Purpose of the Study:

• To explore the factors influencing older adults' decisions to seek acute care from EDs instead of their PCPs.
• To identify key themes in the qualitative experiences of older adults presenting to EDs.

Main Methods:

• A qualitative study employing directed content analysis.
• In-depth interviews with 15 community-dwelling older adults (age ≥65) discharged from an academic medical center's ED.
• Interviews conducted in the ED and patients' homes, audio-recorded, transcribed, and analyzed for emergent themes.

Main Results:

• Five primary themes emerged influencing ED care decisions: limited PCP availability, healthcare system interaction variability, transportation challenges, desire to avoid burdening others, and past illness experiences.
• Participants' decisions were influenced by a complex interplay of personal, social, practical, and experiential factors.
• The average participant age was 74, with 53% female and 80% white.

Conclusions:

• Older adults' decisions to use EDs involve multifaceted personal, social, practical, and experiential considerations.
• Person-centered interventions addressing decision support, telemedicine, transportation, PCP capacity, and ED resources are recommended.
• Future research should validate these findings and inform policy for optimizing care settings for older adults.