Would an ad influence your decision to go to the ER?

Would an ad influence your decision to go to the ER?

You get a terrible headache. What do you do next? Take ibuprofen and try to sleep it off? Call your primary care physician (PCP) for an appointment? Dial 911 for an ambulance to take you to the emergency department (ED)? What if that headache comes with a cough and shaking chills?

Would an ad influence your decision?

I came across this image on Facebook – part of a British campaign launched in late 2011 by the Leicester region of the National Health Service (NHS) in response to winter pressures on their accident and emergency units (A&Es, aka EDs). The campaign website lists the uses for various care options (self-care, pharmacy, general practitioner (aka PCP), urgent care center , emergency department & 999 (translation: 911)) and lets you download an iPhone or Android app to make the choice.

As it turns out, similar campaigns were launched in other regions of the United Kingdom, spurred by a national policy mandate to reduce A&E traffic and and to treat patients in the appropriate medical settings – after all, mismatches cost patients time and money in addition to placing a larger financial burden on the health care system. One such effort in London even involved planting an NHS employee in front of the A&E to redirect patients with minor issues to the on-site primary care clinic.

The ad struck me (and perhaps the 12,500 others who shared it on Facebook) for its uniquely British bluntness and the impression that, even beyond that bluntness, it would be hard to imagine it in the US.

Why is it that we don’t see similar campaigns here (beyond the challenge of laying out our fragmented health care options in a reasonable, app-friendly format)? After all, we struggle with the same issue of overcrowded emergency departments and wasted resources. In 2009, according to the most recent CDC data, Americans made 136 million visits to the ED. Only 12 percent of those visits were for immediate or emergent medical issues while 42 percent of them were considered urgent and 43 percent were semi- or non-urgent.

In the US, we’ve found that access to primary care is a huge factor in Americans going to the emergency room for issues that could have been treated elsewhere, especially for minorities and for patients on Medicaid or without insurance. In one study, researchers asked 31 patients who’d come to the emergency department for a non-urgent medical issue why they’d done so: most said that they couldn’t get an appointment with their PCP, that the PCP’s office staff referred them to the ED, or that they thought it would be faster to go directly to the ED than to go (inevitably) via their PCP. These important challenges demand solutions like more urgent care and after hours clinics as well as easier access to PCPs.

But there’s another factor that is oddly taboo in this discussion: the role that we play as patients (to the extent that we have control) in deciding where to seek care.

When I shared the NHS ad on Facebook, my economist friend Willa Friedman emailed me with her analysis: “So there are at least two explanations: (1) People think they’re special and then under-appreciate/under-change their behavior in response to the impact their actions have on others OR (2) People really have no idea about the options.” What I realized I liked about the ad is that it uses information and a touch of drama to address both factors and in doing so, puts some of the responsibility on patients.

We talk a lot about patient or consumer-driven health care and, separately, about doctors’ roles as stewards of health care resources without allying the two causes and recognizing the important role patients play in this stewardship (Lisa Rosenbaum has some great insights on this issue in her recent article). Instead, we have to ask and enable patients to work with doctors to use the health care system judiciously. That’s why I think this ad is so powerful, and why we in the United States could stand to learn something from it.

Ishani Ganguli is a journalist and an internal medicine-primary care resident who blogs at The Boston Globe’s Short White Coat, where this article originally appeared. 

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  • Suzi Q 38

    I love the picture.
    Try printing it in other languages, as well as English, and pasting them on the FRONT DOOR of every E.R.

    Because our system is not a good one, every patient gets treated at the ER. We should have a small urgent care center on the same parking lot and send 80% of the patients there. Tell the patients that they will be seen for free, too. We give everything FREE. If they go to their doctor, they have to pay cash for the visit or a copay if they have insurance. Yet to do something like walk into an ER, they pay nothing.

    It should be more like this: $20.00 copay for the office visit, $30.00 for the urgent care, and $100.00 co pay for the ER. AT least.
    A shower room and meal station for the druggies and homeless….

    My daughter says she treats all of the above at her ER.
    No wonder so many have had to close.

  • M.K. Caloundra

    Has the ad actually helped ease overcrowding in British emergency departments, though? It doesn’t matter how many people “like” it on Facebook, what matters is whether it’s getting through to the actual people who are habitually fronting up to A & E rather than somewhere more appropriate.

  • M.K. Caloundra

    And as a side note, keeping in mind that neither access to primary care nor cost are issues in the UK, yet they still have overcrowded A & Es and are trying to get people to stop over-using them, why do American fans of the Affordable Care Act think that Obamacare will have any impact on America’s overcrowded EDs?

    The UK is evidence that you can give everyone a GP (PCP) and bring the cost of seeing them down to either nothing or just a very small fee, and you’ll still have problems with A&E/ED overcrowding. There will always be those who, given the choice between waiting to see their GP tomorrow for free or getting treated at A&E tonight for free will choose the latter.

    • trinu

      Obamacare may or may not improve access to primary care; it definitely won’t change the fact that it’s more expensive to go to the ER than see your PCP, unlike in the UK.

      • M.K. Caloundra

        More expensive for the patient, or for the healthcare system? If I’m not mistaken, a lot of Americans who are about to be put on the health insurance rolls are going to be Medicaid beneficiaries (11 million, according to the CBO estimates I’ve seen). Will it cost them any more to go to the ER than to a PCP?

        • trinu

          More expensive to the patient. Of course I’m just talking about the size of the bill, not whether or not the patient skips out on it, as I know many ER free-loaders do.

          • M.K. Caloundra

            Thanks for the input.

    • DT

      “A randomized-controlled study published in the New England Journal of Medicine by a group of nation’s top health policy scholars has found that Medicaid has no measurable effect on any of the objectively measured physical health outcomes the study examined.

      “In its second-year results, the Oregon Health Insurance Experiment… found that those who got Medicaid did not on average have healthier blood pressure, cholesterol levels, or diabetic blood pressure control than those who did not get Medicaid.

      “The Medicaid recipients also ended up utilizing a lot more health care—care that has to be paid for—than those who didn’t get coverage. But they didn’t use the emergency room any less than the control group.”

      via Peter Suderman | May. 1, 2013 7:52 pm | Reason Magazine Online

  • southerndoc1

    In this country, we’re putting up billboards encouraging people to use the ER for prompt, friendly service (said bill boards ONLY being in demogaphically favorable neighborhoods).

  • http://twitter.com/Frontdoor2HC Frontdoor2Healthcare

    And on a related side note, publishing wait times has been touted as another method to address long ER wait times … But just as dangerous as ad campaigns:

    http://www.cbc.ca/news/health/ratemyhospital/story/2013/04/12/hospitals-er-wait-times-rmh.html

  • Taylor H-S

    I saw an ad/running video on the screens around my hospital the other day similar to this ad:

    http://loyolamedicine.org/newswire/features/immediate-care-vs-emergency-care