Table 4:

Health Service Use-Qualitative Outcomes: Interview Themes from Physician’s and Coach’s Perspectives

Health Service Use	Interview Themes	Physician Perspective	Coach Perspective
Return ED Visits	Patients confident they will get needed care in the ED	Well, in this community, I think they [the patients] see the ER, too, like a primary care office. So it’s hard to teach them that it’s not, but I’m [in a different location], so the ER is there… They’re just going to go ahead and go to the emergency room. (2–3PCP)	Coach speaking from patient’s perspective: First and foremost somebody’s going to pay attention to me right away, give me a diagnosis to what’s going on. I have staff around me. (1-C)
	Provider recommends patient go to the ED	Many times their own doctor says go to the emergency department. If they are calling their doctor with chest pain, the reflexive answer has become go to the ER…less and less take care of emergent and acute conditions in their offices as opposed to maybe 10, 15, 25 years ago. (1–5ED) And so basically what I do is I look at the numbers and see what we can accommodate, and also depending on what the message is. If they’re having something that sounds unstable then they’re sent to the emergency room or advised to call 911. If it’s something that sounds like —we should take a look at it first, then we try to accommodate them. (2–2PCP) Do they need to come in right now? Or do they need to go to the emergency room? I would say it’s unusual that from when we (PCPs) get the message that we say go to the emergency room. But I will say that the call center is probably part of their protocol. I don’t know that it’s their protocol but I see the message frequently is the patient was advised if they feel it’s an emergency to go to the emergency room. (2–2PCP)	If something comes up you’re going to call your doctor. A lot of times a doctor is called. There is a triage person there. The information is given to the physician and its’ go to the ER. (1-C)
Hospital Admissions	ED physician decision to admit based on patient ability to get follow-up care	I would say 40 to 50 % fall into that vague area, where it’s a judgement call and you have to take into account that you have some patients could theoretically be discharged, but if I discharge them, what’s going to happen to them at home? Are they going to get the medicines?” (2–5ED) It could take four hours for our patients to get here because of the bus routes. So we actually had to admit some patients because they couldn’t come back for follow-up and take a four-hour bus trip each way. That just wasn’t going to work if they’re—sick. (2–4ED)
Outpatient Visits	Barriers to Care: Difficulty getting an outpatient appointment; inability to perform diagnostic testing	We can’t even do a chem stick in our office. We don’t do any point of care testing at this time. We don’t do EKGs, we don’t provide treatments at the clinic. So we are primarily a coordination of care clinic. (1–3PCP) So some of these patients, they’re trying to get into their PCP and they’re going in at 5:00 in the morning and they’re waiting in line, and they’re not getting seen till 5:00 in the afternoon…So for me personally, I wouldn’t have that patience. Why do that as opposed to go sit in the ED? So I think a lot of the patients actually have a delay in care, as far as primary care. (2–5ED) When they feel like they need to go to see you and you don’t have an opening, they just go to the ER instead of coming to the office. (2–3PCP)	Or the big one is scheduling. They don’t have an opening at that time. So, if that’s the case then go to the emergency room. (1-C) I think a lot of it is there are too few doctors I think for the amount of people that need to see—that were on Medicare in [city]…They don’t want to take those kinds of patients. (2-C)
Hospital Admission Upon ED Return Visit	Role of coach in supporting patient after ED discharge	I think it would be a lot easier for me to discharge patients, and not be so concerned about their safety, knowing that there’s somebody else that was going to ensure that they are safe. (1–4ED]	I think yes, we need to know that you know how to take your medication because you’d be surprised {sometimes the patients] don’t have a clue. (2-C).

ED indicates emergency department; PCP indicates primary care provider; C indicates coach