What patients say about emergency departments and what it means

July 22, 2022

Dr. Vesta Michelle Warren, AMA President

Dear Members, 
 
Our third Care Deficit Assessment Series issue paper regarding emergency departments described the current situation in emergency medicine. Today we bring the voice of patients to that discussion from our June albertapatients.ca survey, which explored patient experiences in the ED. For some of the questions we were able to measure against a 2016 albertapatients study. The full report is worth reading, but here are some important themes.

Why did patients attend the ED? There are several factors here. Visits were higher among patients with chronic conditions who also tend to visit more frequently. It is interesting to note the level of “self-triage” that occurs, whereby patients assess whether their situation is “serious enough” for a trip to the ED: 78% say they asked themselves that question and nearly half (49%) say they decided at least once not to go to the ED. (Expecting to wait is also a deterrent.) 

Almost one-half (46%) of patients – most commonly in those with lower incomes who are under the age of 45 – report that in the past five years, they have personally visited an ED for care because they had no other options available to them at the time (e.g., after hours, didn't have a family doctor/walk-in clinic not available, etc.).

What does it all mean?

What patients have told us with this survey bears out what the Section of Emergency Medicine and other physician leaders have been saying: Lack of access to integrated primary care in the community, upstream of the ED, is contributing significantly to patient loads in the ED. Our study shows that almost half of patients went to an ED as a last resort.

A strong primary care system reduces the burden on emergency medicine and improves the interaction between primary care and secondary/acute care. Every Albertan deserves a medical home of their own in an integrated health neighborhood. Valued allied health professionals like pharmacists and nurse practitioners can deliver the best care to patients and the best value to the system by collaborating in teams that support the medical home within an integrated health neighborhood. Integration requires appropriate data sharing and coordinated management of patient care. We can expand on the outstanding efforts made through primary care networks by using innovation and resources to further advance team-based care and explore new payment models to offer improved access, quality and satisfaction for patients and providers.

I recently received a document from the Canadian Medical Forum that reflects nationally what we are seeing in Alberta. The CMF has issued “an urgent call to action for health care system improvements in support of comprehensive primary health care.” Health policy tables around Alberta have heard for many years the evidence that “patients who have a family doctor have better health outcomes and live longer.” We would also expect that living better and longer means less time in the emergency department.

Your thoughts and comments are welcome on this letter or anything else that’s on your mind. You can reach me any time in the following ways:

  • Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org.
  • Comment publicly on this President’s Letter (please be aware that comments are public, i.e., not members-only, even if you are logged in as a member).

Sincerely,

Vesta Michelle Warren, MD, CCFP, FCFP
President, Alberta Medical Association

3 comments

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  • #1

    This comment has been deleted.

  • #2

    Paul MARNER

    Physician

    12:19 PM on July 22, 2022

    Unfortunately lay people and especially politicians do not recognize or value preventative care. It is easy to measure numbers of dead bodies, hospital and ER admissions. Measuring "wellness" is more problematic except to statisticians.
    In general we are living longer, but not always better lives so we know, if we care, that the medical fraternity is helping, against odds!

  • #3

    Noel Corser

    Physician

    9:21 AM on July 25, 2022

    It's been said that the ER is the "canary in the coal mine" for the healthcare system - where catastrophic system failings first show up. Although supporting the canary is obviously important for the canary's sake, it's foolish to not find and stop the source of the gas leak! We should be well past viewing comprehensive and integrated primary care as an optional "bonus" feature of a healthcare system, and recognize it for what it is - the system's backbone. Without a backbone, the whole thing staggers and falls.

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