People who come to Dunedin Hospital's emergency department often feel guilty about being there but see it as their only option, Dr Anne Worsnop says.
Dr Worsnop, the Otago District Health Board general practitioner liaison officer, surveyed some patients seeking treatment at the department during April to find out why they chose that option.
The board has been concerned for some time about the number of people attending the pressured department who could be treated elsewhere.
It has been suggested that as many as one-fifth of the 37,000 patients seen yearly are in that category.
In a report to be considered by the board at its meeting tomorrow, Dr Worsnop said her overwhelming impression was that people did not lightly choose to go to the department.
Her interviews suggested the message about keeping the emergency department for emergencies had got through to all people save those patients aged 15 to 25 (most of whom were not students).
This age group made up about a quarter of the numbers seen in both the day and the evening. Other patients had carefully explored their options before coming, although there was some ignorance about the capability of the urgent doctors centre.
She suggested 15- to 25-year-olds needed to be targeted in any advertising aimed at having people think twice about using the department as the first line of medical treatment. More than 40% of the surveyed people of this age who had been seen in the evenings were unaware of the service provided by Dunedin Urgent Doctors and Accident Centre.
The group also had the highest numbers of people arriving with non-urgent conditions (classed as triage four and five, meaning they should be seen within an hour or two hours, respectively).
She also asked if a subsidy for those in this age group seeking medical attention in the community would be useful to keep numbers down in the department and teach young people about the importance of being attached to a GP for ongoing and consistent care.
Her study involved patients who arrived during 60 half-hour slots between 8am and 5pm and 5pm and 11.30pm, randomly selected over three weeks.
Weekends were not included.
Of the 153 people in the survey, most came during the day, with the remaining 57 seeking treatment in the evening.
Dr Worsnop found 70% of those attending during the day had been referred to the department by GPs, Dunedin Urgent Doctors and Accident Centre, ambulance personnel or another hospital professional.
In the evening, however, about half of those who sought treatment were not referred by anybody.
About one-third of these people did not know about the urgent doctors centre, one-fifth thought it cost too much and almost two-fifths thought the centre could not help.
Dr Worsnop said these were small numbers, and further study of them might be needed.
Five of the patients who came to the department by ambulance were in the least urgent triage categories.
The ambulance was not funded to deliver patients to a GP or the urgent doctors centre.
Giving such funding to the service would keep a few patients in the community, being treated by their GP or the urgent doctors centre, Dr Worsnop said.
In his report to the board, chief executive Brian Rousseau said management was meeting the Ministry of Health on July 7 to discuss solutions to the pressure on the department.
He said it was possible that the work looking at ways to reduce attendance could override discussions with the urgent doctors centre concerning payment for the " graveyard shift", when cover was provided by the department for Dunedin GPs (apart from those at Mornington Health Centre, which provided its own on-call doctor).
