Emergency Departments as Care Providers for Patients with Cardiac Ambulatory Care Sensitive and Mental Health Conditions: Qualitative Interview and Focus Group Study with Patients and Physicians

TY - JOUR

T1 - Emergency Departments as Care Providers for Patients with Cardiac Ambulatory Care Sensitive and Mental Health Conditions: Qualitative Interview and Focus Group Study with Patients and Physicians

AU - Schmiedhofer, Martina

AU - Slagman, Anna

AU - Kuhlmann, Stella Linea

AU - Figura, Andrea

AU - Oslislo, Sarah

AU - Schneider, Anna

AU - Schenk, Liane

AU - Rose, Matthias

AU - Möckel, Martin

PY - 2022/5/17

Y1 - 2022/5/17

N2 - Mental health conditions are frequent among patients with somatic illnesses, such as cardiac diseases. They often remain undiagnosed and are related to increased utilization of outpatient services, including emergency department care. The objective of this qualitative study was to investigate the significance of the emergency department in the patients' course of treatment and from the physicians' perspective. An improved understanding of the subjective needs of this specific patient group should provide hints for targeted treatment. This study is part of the prospective EMASPOT study, which determined the prevalence of mental health conditions in emergency department patients with cardiac ambulatory care sensitive conditions. The study on hand is the qualitative part, in which 20 semi-structured interviews with patients and a focus group with six ED physicians were conducted. Data material was analyzed using the qualitative content analysis technique, a research method for systematically identifying themes or patterns. For interpretation, we used the "typical case approach". We identified five "typical patient cases" that differ in their cardiac and mental health burden of disease, frequency and significance of emergency department and outpatient care visits: (1) frequent emergency department users with cardiac diseases and mental health conditions, (2) frequent emergency department users without cardiac diseases but with mental health conditions, (3) needs-based emergency department users with cardiac diseases; (4) targeted emergency department users as an alternative to specialist care and (5) patients surprised by initial diagnose of cardiac disease in the emergency department. While patients often perceived the emergency department visit itself as a therapeutic benefit, emergency department physicians emphasized that frequent examinations of somatic complaints can worsen mental health conditions. To improve care, they proposed close cooperation with the patients' primary care providers, access to patients' medical data and early identification of mental health conditions after cardiac diagnoses, e.g., by an examination tool.

AB - Mental health conditions are frequent among patients with somatic illnesses, such as cardiac diseases. They often remain undiagnosed and are related to increased utilization of outpatient services, including emergency department care. The objective of this qualitative study was to investigate the significance of the emergency department in the patients' course of treatment and from the physicians' perspective. An improved understanding of the subjective needs of this specific patient group should provide hints for targeted treatment. This study is part of the prospective EMASPOT study, which determined the prevalence of mental health conditions in emergency department patients with cardiac ambulatory care sensitive conditions. The study on hand is the qualitative part, in which 20 semi-structured interviews with patients and a focus group with six ED physicians were conducted. Data material was analyzed using the qualitative content analysis technique, a research method for systematically identifying themes or patterns. For interpretation, we used the "typical case approach". We identified five "typical patient cases" that differ in their cardiac and mental health burden of disease, frequency and significance of emergency department and outpatient care visits: (1) frequent emergency department users with cardiac diseases and mental health conditions, (2) frequent emergency department users without cardiac diseases but with mental health conditions, (3) needs-based emergency department users with cardiac diseases; (4) targeted emergency department users as an alternative to specialist care and (5) patients surprised by initial diagnose of cardiac disease in the emergency department. While patients often perceived the emergency department visit itself as a therapeutic benefit, emergency department physicians emphasized that frequent examinations of somatic complaints can worsen mental health conditions. To improve care, they proposed close cooperation with the patients' primary care providers, access to patients' medical data and early identification of mental health conditions after cardiac diagnoses, e.g., by an examination tool.

KW - Ambulatory Care

KW - Emergency Service, Hospital

KW - Focus Groups

KW - Heart Diseases/epidemiology

KW - Humans

KW - Mental Health

KW - Physicians

KW - Prospective Studies

U2 - 10.3390/ijerph19106098

DO - 10.3390/ijerph19106098

M3 - SCORING: Journal article

C2 - 35627633

VL - 19

JO - INT J ENV RES PUB HE

JF - INT J ENV RES PUB HE

SN - 1660-4601

IS - 10

M1 - 6098

ER -