Inappropriate use of emergency services: a systematic review of prevalence and associated factors Prevalência e fatores associados ao uso inadequado do serviço de emergência: uma revisão sistemática da literatura

This systematic review aimed to measure the prevalence of inappropriate emergency department (ED) use by adults and associated factors. The review included 31 articles published in the last 12 years. Prevalence of inappropriate ED use varied from 20 to 40% and was associated with age and income. Female patients, those without co-morbidities, without a regular physician, without a regular source of care, and those not referred to the ED by a physician also showed more inappropriate ED use, with the relative risk varying from 1.12 to 2.42. Difficulties in accessing primary health care (difficulties in setting appointments, longer waiting periods, and short business hours at the primary health care service) were also associated with inappropriate ED use. Thus, primary care requires fully qualified patient reception and efficient triage to promptly attend cases that cannot wait. It is also necessary to orient the population on situations in which they should go to the ED and on the disadvantages of consulting the ED when the case is not really urgent. Emergency Medical Services; Health Services Misuse; Adult; Evaluation Studies Introduction Emergency treatment aims to perform procedures to immediately relieve well-circumscribed situations, and is not intended to include on-going care 1. However, patients frequently seek the emergency department (ED) to obtain immediate attention in order to perform tests and administer medication to relieve symptoms. Although this may appear appropriate from the patient’s perspective (given existing limitations in other levels of health care), this type of use places a burden on the health system and increases the demand on the ED for care that could be managed better at other levels and that in a sense competes with true emergency cases. Meanwhile, such demand generates a kind of care that fails to create a bond with the health service (in which patients would receive not only treatment to relieve their immediate symptoms, but also health education) or to link with on-going care in order to prevent complications and new illnesses 2,3,4. Such use of ED services is thus considered inappropriate. The inappropriate use of ED services is a common problem in various countries, and the issue has thus been studied for more than two decades 5. However, the wide range of criteria used to define inappropriate use of ED services has been an obstacle to systematic reviews on the topic 6. Numerous studies have evaluated its prevalence and many have also examined factors associated with such inappropriate use, but most REVISÃO REVIEW