Challenges of Acute Care in the Urban Setting from an Interdisciplinary Perspective: Qualitative Study

DOI: 10.3238/zfa.2020.0394-0399

german translation / full article

Sarah Oslislo, Christoph Heintze, Martin Möckel, Felix Holzinger

Keywords: emergency department health care services research interdisciplinary qualitative research

BackgroundEmergency and acute care in Germany is currently faced with numerous challenges, including a rising patient-initiated utilization of hospital emergency departments. A variety of health policy measures aimed at better steering have been initiated or are planned for the near future. In order to evaluate the current challenges of acute care in detail from an interdisciplinary perspective, focus group discussions were conducted as part of the EMACROSS study.MethodsTwo interdisciplinary focus groups with a total of 10 participants (family physicians, ambulatory pulmonologists and physicians working in emergency departments); discussions were guided by a semi-structured interview guideline; qualitative content analysis was performed on the material.ResultsCommunication within ambulatory care as well as between sectors was depicted as fraught with problems. Issues critically thematized by the participants included a lack of professional experience of physicians working in emergency departments as well as referrals of non-urgent patients by ambulatory care providers. A shortage of timely appointments was seen as a possible driver of potentially preventable referrals. With regard to patients, a deficient capacity to judge symptoms adequately was depicted; this could potentially be aggravated by online content. In the view of discussion participants, patients also frequently lack awareness of the costs associated with their utilization.ConclusionsThe focus group discussions paint a complex and multi-faceted picture concerning the current problem areas and challenges of acute care. Intra- and inter-sectoral thresholds appear to be of special importance in this context. In the light of heterogeneous scientific evidence, the effects of current political measures for patient steering remain to be seen.Keywordsemergency department; health care services research; qualitative research; interdisciplinary; focus group

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