ReviewHealth expectations : an international journal of public participation in health care and health policy2020
'Clinically unnecessary' use of emergency and urgent care: A realist review of patients' decision making.
Review in Health expectations : an international journal of public participation in health care and health policy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
47 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- An instrument as an action against the blind spot of acute medical care in general practice - a systematic review.BMC primary care · 2025Pooled it
- Pooled it
- Factors influencing general practitioners decisions to refer Paediatric patients to the emergency department: a systematic review and narrative synthesis.BMC family practice · 2020Pooled it
- Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare - systematic review.BMC health services research · 2020Pooled it
- Factors Influencing Non-urgent Emergency Department Visits: A Review of the Causes and Impact.Cureus · 2026Review
- Distress, Discomfort and Moral Injury: Emergency Department Clinicians Experiences Caring for People With a Psychosocial Disability and a National Disability Insurance Scheme Plan.International journal of mental health nursing · 2026Article
- Factors associated with avoidable non-urgent emergency department visits in South Tyrol (Italy): a multicentre cross-sectional study.BMC emergency medicine · 2026Article
- Winter all year round in urgent and emergency care: a large retrospective analysis of routinely collected NHS data across England, 2021-2022.BMC health services research · 2026Observational
- Barriers to continuity of outpatient infusion-port maintenance among patients with cancer: a single-center cross-sectional study in China.Frontiers in public health · 2026Observational
- Why do patients attend out-of-hours GP services in Ireland?Irish journal of medical science · 2025Article
- Why do patients seek emergency care for problems that could be managed in primary care? A scoping review.Family practice · 2025Article
- Quality and outcomes framework achievement and unplanned admissions for cardiovascular disease.BMC health services research · 2025Article
- Patients' perceptions on reasons for self-referring to the emergency department shortly before a cancer diagnosis: a qualitative study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Article
- Urgent Care Centre Eligible Presentations in a Remote Emergency Department.Emergency medicine Australasia : EMA · 2025Article
- Examining Pediatric Emergency Utilization Trends Before and After the COVID-19 Pandemic: An Eight-Year Cohort Study from a South Korean Tertiary Center.Children (Basel, Switzerland) · 2025Article
- Staff Experiences with the Implementation of Nurse Practitioner (NP)-led Clinics in New Brunswick, Canada.The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres · 2025Article
- Public perceptions toward primary care in Kuwait: a cross-sectional study.Frontiers in medicine · 2025Article
- The role of family health centres in preventing paediatric emergency department usage of parents of children with non-urgent conditions.BMC primary care · 2024Article
- Role of communicating diagnostic uncertainty in the safety-netting process: insights from a vignette study.BMJ quality & safety · 2024Article
- Emergency care in Brazil: factors leading to clinically inappropriate use of emergency care among young adult users in the Brazilian context.BMC health services research · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
Abstract
backgroundDemand is labelled 'clinically unnecessary' when patients do not need the levels of clinical care or urgency provided by the service they contact.
objectiveTo identify programme theories which seek to explain why patients make use of emergency and urgent care that is subsequently judged as clinically unnecessary.
designRealist review.
methodsPapers from four recent systematic reviews of demand for emergency and urgent care, and an updated search to January 2017. Programme theories developed using Context-Mechanism-Outcome chains identified from 32 qualitative studies and tested by exploring their relationship with existing health behaviour theories and 29 quantitative studies.
resultsSix mechanisms, based on ten interrelated programme theories, explained why patients made clinically unnecessary use of emergency and urgent care: (a) need for risk minimization, for example heightened anxiety due to previous experiences of traumatic events; (b) need for speed, for example caused by need to function normally to attend to responsibilities; (c) need for low treatment-seeking burden, caused by inability to cope due to complex or stressful lives; (d) compliance, because family or health services had advised such action; (e) consumer satisfaction, because emergency departments were perceived to offer the desired tests and expertise when contrasted with primary care; and (f) frustration, where patients had attempted and failed to obtain a general practitioner appointment in the desired timeframe. Multiple mechanisms could operate for an individual.
conclusionsRather than only focusing on individuals' behaviour, interventions could include changes to health service configuration and accessibility, and societal changes to increase coping ability.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.