Why do patients seek emergency care for problems that could be managed in primary care? A scoping review

Emergency care systems worldwide are increasingly facing capacity challenges. A significant number of people are using emergency care, including the use of emergency departments and ambulance services, for conditions that could be managed in primary care settings, potentially creating unnecessary strains on the already heavily burdened emergency care systems, leading to overcrowding, inefficient use of healthcare resources, and inadequate access to emergency care for those in need.

This scoping review of the literature aimed to explore existing evidence considering the multifaceted factors contributing to patients' decisions to seek emergency care for conditions manageable in primary care.

A comprehensive search of "PubMed", "Embase", "MEDLINE", "CINAHL" and "the Cochrane Library" was conducted, including peer-reviewed articles published from Jan 1st 2004, until June 15th 2024. This review was conducted following the methodological framework presented by Arksey and O'Malley.

A total of 44 studies conducted in 21 countries worldwide were included in the final analysis. Key data were extracted and analysed using thematic analysis, and the following themes have been identified: (1) accessibility and convenience, (2) health anxiety, (3) uncertainty and knowledge gaps in healthcare services, (4) external advice and encouragement, and (5) personal influences.

Our study maps the existing international literature to inform researchers and policymakers on possible future development of efficient alternative care frameworks and pathways designed to alter emergency care utilisation behaviours, ultimately reducing unnecessary visits and ensuring efficient care is provided for true emergencies.