A.CHOW1, B. KENG1, H. GUO1, A.H. AUNG1, Z. HUANG1, Y. WENG1, H. ANG1
Tan Tock Seng Hospital1, National Centre for Infectious Diseases2
Upper respiratory tract infections(URTIs) account for substantial non-urgent emergency department(ED) attendances. We explored the reasons using a mixed-methods approach.
We interviewed a cohort of 717 URTI patients who visited TTSH ED, June 2016-Nov 2018, on their expectations and reasons for attendance and accessed their electronic health records. Using the Andersen’s Behavioral Model for Healthcare Utilization, topmost reasons for ED attendances were categorized into: 1) contextual predisposing factors(referral by physician/family/friend), 2) contextual enabling factors(convenience, accessibility, employment requirements), 3) individual enablers (personal preference and trust in hospital), and 4) individual needs(perceived illness severity and non-improvement). Multivariable multinomial logistic regression was constructed to assess associations between socio-demographic and clinical factors, visit expectations, and drivers for ED attendance.
Participant’s mean age was 40.5(±14.7)years, 61.2% were males, 66.5% without comorbidities, and 40.7% diploma/degree holders. Individual needs(32.8%) and enablers(25.1%) were main drivers for ED attendances. Compared to patients attending due to contextual enabling factors, patients attending because of other drivers tended to be aged ³45 years, have prior medical consultation, and expect radiologic investigations(P<0.05). Having pre-existing medical conditions(aOR 1.78, 95%CI 1.05-3.04) and expectation for laboratory tests(aOR 1.64, 95%CI 1.01-2.64) were additionally associated with individual needs. Being non-diploma/degree holder(aOR 2.04, 95%CI 1.22-3.45) and having pre-existing comorbidities(aOR 1.79, 95%CI 1.04-3.10) were associated with individual enablers.
Patients’ socio-demographic and clinical factors, and ED visit expectations, influence their motivations for ED attendances for URTI. Public education on URTI management, services at primary care clinics and the non-misuse of ED for the public good, can reduce ED attendances for uncomplicated URTI.