Motivations for Seeking Emergency Department Care Among Rural and Urban Patients

Wednesday, July 13, 2011: 2:25 PM

Sarah Lawson, PhD, RN
School of Nursing and Health Studies, University of Miami, Coral Gables, FL
Audrey Snyder, PhD, RN, ACNP-CS, CEN, FAEN, FAANP
School of Nursing, University of Virginia, Charlottesville, VA
Sandra Annan, PhD, RN
School of Nursing, James Madison University, Harrisonburg, VA

Learning Objective 1: Identify three reasons motivating patients to seek care at an Emergency Department as opposed to utilizing local health care options.

Learning Objective 2: Discuss several of the barriers identified by study participant patients that will assist in improving access to local care providers.

Purpose: Health needs and problems in the rural setting are often different than in non-rural areas with a higher proportion of people living in rural communities have complex illnesses.  People living in rural areas often bypass local health care options, presenting to larger hospitals far from home for care.  This pilot study examines, from the patients’ perspectives, why both rural and urban residents seek medical care in a non-rural emergency department (ED). The aim of the study was to gain a better understanding of issues related to accessing health care by identifying barriers and challenges for persons presenting to a non-rural ED for health care as opposed to local medical services.

Methods: This pilot study was a mixed-methods descriptive examination of the experiences of those seeking health care in a non-rural ED. Qualitative data was collected by in-person interviews after the demographic survey form was completed. 

Results: Of the fifty participants enrolled in the study, 22 (44%) were male and 28 (56%) were female ranging in age from 9 to 82 (41.6 + 17.6).  Forty-two (84%)  described where they lived to be a rural area, small rural town or small town.  Barriers to accessing healthcare include cost, lack of insurance, lack of primary care providers, lack of transportation, and the time involved to access care. Challenges for patients include obtaining an appointment for follow-up after being seen in an ED, the lack of PCPs in their home area, difficulty seeing the same doctor more than once, and the lack of mental health services.

Conclusion: The ED continues to be a safety net for patients who have difficulty accessing the health care system. The identified barriers provide opportunities for healthcare system improvements, healthcare provider education, public education and continued research to ultimately improve access to care outside of the ED setting.