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Huang Z, Natarajan K, Lim HC, Weng Y, Tan HY, Seow E, Peng LL, Ow JT, Kuan WS, Chow A. Applying Andersen's healthcare utilization model to assess factors influencing patients' expectations for diagnostic tests at emergency department visits during the COVID-19 pandemic. Front Public Health 2023; 11:1250658. [PMID: 38074705 PMCID: PMC10701756 DOI: 10.3389/fpubh.2023.1250658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/11/2023] [Indexed: 12/18/2023] Open
Abstract
Background The uncertainties surrounding the COVID-19 pandemic led to a surge in non-urgent emergency department (ED) attendance among people presenting with upper respiratory tract infection (URTI) symptoms. These non-urgent visits, often manageable in primary care, exacerbated ED overcrowding, which could compromise the quality of ED services. Understanding patients' expectations and the reasons for these ED visits is imperative to mitigate the problem of ED overcrowding. Hence, we assessed the factors influencing patients' expectations for diagnostic tests during their ED visits for uncomplicated URTI during different phases of the pandemic. Methods We conducted a cross-sectional study on adults with URTI symptoms seeking care at four public EDs in Singapore between March 2021 and March 2022. We segmented the study period into three COVID-19 pandemic phases-containment, transition, and mitigation. The outcome variables are whether patients expected (1) a COVID-19-specific diagnostic test, (2) a non-COVID-19-specific diagnostic test, (3) both COVID-19-specific and non-COVID-19-specific diagnostic tests, or (4) no diagnostic test. We built a multinomial regression model with backward stepwise selection and classified the findings according to Andersen's healthcare utilization model. Results The mean age of participants was 34.5 (12.7) years. Factors (adjusted odds ratio [95% confidence interval]) influencing expectations for a COVID-19-specific diagnostic test in the ED include younger age {21-40 years: (2.98 [1.04-8.55])}, no prior clinical consultation (2.10 [1.13-3.89]), adherence to employer's health policy (3.70 [1.79-7.67]), perceived non-severity of illness (2.50 [1.39-4.55]), being worried about contracting COVID-19 (2.29 [1.11-4.69]), and during the transition phase of the pandemic (2.29 [1.15-4.56]). Being non-employed influenced the expectation for non-COVID-19-specific diagnostic tests (3.83 [1.26-11.66]). Factors influencing expectations for both COVID-19-specific and non-COVID-19-specific tests include younger age {21-40 years: (3.61 [1.26-10.38]); 41-60 years: (4.49 [1.43-14.13])}, adherence to employer's health policy (2.94 [1.41-6.14]), being worried about contracting COVID-19 (2.95 [1.45- 5.99]), and during the transition (2.03 [1.02-4.06]) and mitigation (2.02 [1.03-3.97]) phases of the pandemic. Conclusion Patients' expectations for diagnostic tests during ED visits for uncomplicated URTI were dynamic across the COVID-19 pandemic phases. Expectations for COVID-19-specific diagnostic tests for ED visits for uncomplicated URTI were higher among younger individuals and those worried about contracting COVID-19 during the COVID-19 pandemic. Future studies are required to enhance public communications on the availability of diagnostic services in primary care and public education on self-management of emerging infectious diseases such as COVID-19.
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Affiliation(s)
- Zhilian Huang
- Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge [OCEAN], Tan Tock Seng Hospital, Singapore, Singapore
| | - Karthiga Natarajan
- Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge [OCEAN], Tan Tock Seng Hospital, Singapore, Singapore
| | - Hoon Chin Lim
- Department of Accident and Emergency, Changi General Hospital, Singapore, Singapore
| | - Yanyi Weng
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hann Yee Tan
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Eillyne Seow
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Li Lee Peng
- Department of Emergency Medicine, National University Hospital, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jing Teng Ow
- Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge [OCEAN], Tan Tock Seng Hospital, Singapore, Singapore
| | - Win Sen Kuan
- Department of Emergency Medicine, National University Hospital, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Angela Chow
- Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge [OCEAN], Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Korczak V, Yakubu K, Angell B, Middleton P, Dinh M, Lung T, Jan S. Understanding patient preferences for emergency care for lower triage acuity presentations during GP hours: a qualitative study in Australia. BMC Health Serv Res 2022; 22:1442. [PMID: 36447196 PMCID: PMC9706995 DOI: 10.1186/s12913-022-08857-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Low acuity presentations to Australian emergency departments drive long wait times, higher costs and may be better treated in primary care settings. This study sought to understand factors leading these patients to present to emergency departments. METHODS Semi-structured interviews were carried out with patients at two tertiary emergency departments in Sydney during general practitioner opening hours. Nvivo was used to code the interviews and a thematic analysis was carried out to capture the main themes from the interviews. RESULTS Forty-four interviews were included in the analysis across the two sites. They represented a diverse population in terms of ethnicity, education and socioeconomic background. Patient preferences for emergency care were organised into four main themes: (i) patients were referred (either by another health service, work, friend, or family), (ii) emergency department factors (convenience of investigations and severity of symptoms requiring emergency care), (iii) GP factors (does not have a GP, cannot find an appointment with a GP or has previously had a negative experience with a GP) and (iv) personal factors such as their connection to the hospital. CONCLUSION Multiple factors led patients to seek ED care for low acuity presentations during GP hours. Some of these factors could be addressed to meet patient needs in the community, however this is currently not the case. Addressing these factors to improve access to GP clinics and the availability of services outside the hospital setting could reduce ED presentations and likely improve patient experience.
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Affiliation(s)
- Viola Korczak
- grid.1005.40000 0004 4902 0432The George Institute for Global Health, University of New South, Sydney, Australia ,grid.413249.90000 0004 0385 0051The Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Kenneth Yakubu
- grid.1005.40000 0004 4902 0432The George Institute for Global Health, University of New South, Sydney, Australia
| | - Blake Angell
- grid.1005.40000 0004 4902 0432The George Institute for Global Health, University of New South, Sydney, Australia ,grid.1005.40000 0004 4902 0432Faculty of Medicine and Health, The University of New South, Sydney, Australia
| | - Paul Middleton
- grid.429098.eSouth Western Emergency Research Institute, Ingham Institute, Liverpool, Australia ,grid.1005.40000 0004 4902 0432South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Michael Dinh
- grid.413249.90000 0004 0385 0051The Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Camperdown, Australia ,NSW Agency of Trauma and Injury Management, PRISM, Agency for Clinical Innovation, St Leonards, Australia
| | - Thomas Lung
- grid.1005.40000 0004 4902 0432The George Institute for Global Health, University of New South, Sydney, Australia ,grid.1005.40000 0004 4902 0432Faculty of Medicine and Health, The University of New South, Sydney, Australia
| | - Stephen Jan
- grid.1005.40000 0004 4902 0432The George Institute for Global Health, University of New South, Sydney, Australia ,grid.1005.40000 0004 4902 0432Faculty of Medicine and Health, The University of New South, Sydney, Australia
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