The association between illness representation profiles and use of unscheduled urgent and emergency health care services

Objectives. Provision of unscheduled health care (e.g., emergency department, family doctor consultations, pharmacist) is aided by matching patients with the 'right service, first time'. However, service choice is usually made by patients and carers rather than service providers. The self-regulation model (SRM) posits that people cope in ways consistent with their illness understanding. The SRM was used to examine differences in people's use of primary, secondary, and community health care services according to their illness representation, whilst also examining associations with chronic illness. Research historically treats illness representations at the level of independent components; this research focused on components as sets (profiles). Design and methods. A general population postal survey obtained usable data from 588 respondents on service usage and illness representation. Results. Cluster analysis detected three illness representation profiles (participant groups) comprising people who regarded their illness as serious, unambiguous, distressing, and difficult to manage (group 1); chronic and concerning, but believing they understood and could manage it (group 2); short-term, of limited impact or concern but ambiguous in nature (group 3). Overall, group 1 used secondary care more than the other groups. When considering illness chronicity, group 1 showed more use of primary care with non-chronic conditions and secondary care with chronic conditions. Conclusions. Findings highlighted differences in use of unscheduled services that were related to illness representation profiles. Interventions for moderating service use such as patient information campaigns may need to be tuned towards specific groups of service users to optimize impact.