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The impact of neighborhood deprivation on patients' unscheduled out-of-hours healthcare seeking behavior: a cross-sectional study

Sara Willems (UGent) , Wim Peersman (UGent) , Philippe De Maeyer (UGent) , Walter Buylaert (UGent) , Jan De Maeseneer (UGent) and Peter De Paepe (UGent)
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Abstract
Background: The use of unscheduled out of hours medical care is related to the social status of the patient. However, the social variance in the patient's preference for a hospital based versus a primary care based facility, and the impact of specific patient characteristics such as the travel distance to both types of facilities is unclear. This study aims to determine the social gradient in emergency care seeking behavior (consulting the emergency department (ED) in a hospital or the community-based Primary Care Center (PCC)) taking into account patient characteristics including the geographical distance from the patient's home to both services. Methods: A cross-sectional study, including 7,723 patients seeking out-of-hours care during 16 weekends and 2 public holidays was set up in all EDs and PCCs in Ghent, Belgium. Information on the consulted type of service, and neighborhood deprivation level was collected, but also the exact geographical distance from the patient's home to both types of services, and if the patient has a regular GP. Results: Patients living in a socially deprived area have a higher propensity to choose a hospital-based ED than their counterparts living in more affluent neighborhoods. This social difference persists when taking into account distance to both services, having a regular GP, and being hospitalized or not. The impact of the distance between the patient's home address and the location of both types of services on the patient's choice of service is rather small. Conclusions: Initiatives aiming to lead patients more to PCC by penalizing inappropriate ED use might increase health inequity when they are not twinned with interventions improving the access to primary care services and tackling the underlying mechanisms of patients' emergency care seeking behavior. Further research exploring the impact of out-of-hours care organization (gatekeeping, payment systems, ...) and the patient's perspectives on out-of-hours care services is needed.
Keywords
Neighborhood deprivation, REASONS, INSURANCE, IMMIGRANT, EMERGENCY-DEPARTMENT, GENERAL-PRACTICE, ACCIDENT, ACCESS, SOCIOECONOMIC-STATUS, SERVICES, Out of hours care, Health care delivery, Emergency care, Primary health care, Primary care centre, Social class

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MLA
Willems, Sara et al. “The Impact of Neighborhood Deprivation on Patients’ Unscheduled Out-of-hours Healthcare Seeking Behavior: a Cross-sectional Study.” BMC FAMILY PRACTICE 14 (2013): n. pag. Print.
APA
Willems, Sara, Peersman, W., De Maeyer, P., Buylaert, W., De Maeseneer, J., & De Paepe, P. (2013). The impact of neighborhood deprivation on patients’ unscheduled out-of-hours healthcare seeking behavior: a cross-sectional study. BMC FAMILY PRACTICE, 14.
Chicago author-date
Willems, Sara, Wim Peersman, Philippe De Maeyer, Walter Buylaert, Jan De Maeseneer, and Peter De Paepe. 2013. “The Impact of Neighborhood Deprivation on Patients’ Unscheduled Out-of-hours Healthcare Seeking Behavior: a Cross-sectional Study.” Bmc Family Practice 14.
Chicago author-date (all authors)
Willems, Sara, Wim Peersman, Philippe De Maeyer, Walter Buylaert, Jan De Maeseneer, and Peter De Paepe. 2013. “The Impact of Neighborhood Deprivation on Patients’ Unscheduled Out-of-hours Healthcare Seeking Behavior: a Cross-sectional Study.” Bmc Family Practice 14.
Vancouver
1.
Willems S, Peersman W, De Maeyer P, Buylaert W, De Maeseneer J, De Paepe P. The impact of neighborhood deprivation on patients’ unscheduled out-of-hours healthcare seeking behavior: a cross-sectional study. BMC FAMILY PRACTICE. 2013;14.
IEEE
[1]
S. Willems, W. Peersman, P. De Maeyer, W. Buylaert, J. De Maeseneer, and P. De Paepe, “The impact of neighborhood deprivation on patients’ unscheduled out-of-hours healthcare seeking behavior: a cross-sectional study,” BMC FAMILY PRACTICE, vol. 14, 2013.
@article{4172277,
  abstract     = {Background: The use of unscheduled out of hours medical care is related to the social status of the patient. However, the social variance in the patient's preference for a hospital based versus a primary care based facility, and the impact of specific patient characteristics such as the travel distance to both types of facilities is unclear. This study aims to determine the social gradient in emergency care seeking behavior (consulting the emergency department (ED) in a hospital or the community-based Primary Care Center (PCC)) taking into account patient characteristics including the geographical distance from the patient's home to both services.
Methods: A cross-sectional study, including 7,723 patients seeking out-of-hours care during 16 weekends and 2 public holidays was set up in all EDs and PCCs in Ghent, Belgium. Information on the consulted type of service, and neighborhood deprivation level was collected, but also the exact geographical distance from the patient's home to both types of services, and if the patient has a regular GP.
Results: Patients living in a socially deprived area have a higher propensity to choose a hospital-based ED than their counterparts living in more affluent neighborhoods. This social difference persists when taking into account distance to both services, having a regular GP, and being hospitalized or not. The impact of the distance between the patient's home address and the location of both types of services on the patient's choice of service is rather small.
Conclusions: Initiatives aiming to lead patients more to PCC by penalizing inappropriate ED use might increase health inequity when they are not twinned with interventions improving the access to primary care services and tackling the underlying mechanisms of patients' emergency care seeking behavior. Further research exploring the impact of out-of-hours care organization (gatekeeping, payment systems, ...) and the patient's perspectives on out-of-hours care services is needed.},
  articleno    = {136},
  author       = {Willems, Sara and Peersman, Wim and De Maeyer, Philippe and Buylaert, Walter and De Maeseneer, Jan and De Paepe, Peter},
  issn         = {1471-2296},
  journal      = {BMC FAMILY PRACTICE},
  keywords     = {Neighborhood deprivation,REASONS,INSURANCE,IMMIGRANT,EMERGENCY-DEPARTMENT,GENERAL-PRACTICE,ACCIDENT,ACCESS,SOCIOECONOMIC-STATUS,SERVICES,Out of hours care,Health care delivery,Emergency care,Primary health care,Primary care centre,Social class},
  language     = {eng},
  pages        = {9},
  title        = {The impact of neighborhood deprivation on patients' unscheduled out-of-hours healthcare seeking behavior: a cross-sectional study},
  url          = {http://dx.doi.org/10.1186/1471-2296-14-136},
  volume       = {14},
  year         = {2013},
}

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