Public Perspectives on Decisions About Emergency Care Seeking for Care Unrelated to COVID-19 During the COVID-19 Pandemic

Background. Previous policy implementation in 2012 to incentivize private hospitals in Thailand, a country with universal health coverage, to provide free-of-charge emergency care using DRG-based payment resulted in an equity gap of access and copayment. To bridge the gap, strategic policies involving financial and legal interventions were implemented in 2017. This study aims to assess whether this new approach would be able to fill the gap. Methods. We analyzed an administrative dataset of over 20,206 patients visiting private hospital EDs from April 2017 to October 2017 requested for the preauthorization of access to emergency care in the first 72 hours free of charge. The association between types of insurance and the approval status was explored using logistic regression equation adjusting for age, modes of access, systolic blood pressure, respiratory rate, and Glasgow coma scores. Results and Discussion. The strategic policies implementation resulted in reversing ED payer mix from the most privileged scheme, having the major share of ED visit, to the least privileged scheme. The data showed an increasing trend of ED visits to private hospitals indicates the acceptance of the financial incentive. Obvious differences in degrees of urgency between authorized and unauthorized patients suggested the role of preauthorization as a barrier to the noncritical patient visiting the ED. Furthermore, our study depicted the gender disparity between authorized and unauthorized patients which might indicate a delay in care seeking among critical female patients. Lessons learned for policymakers in low-and-middle income countries attempting to close the equity gap of access to private hospital EDs are discussed.

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Characterization of Emergency Care-seeking Patterns for Nontraumatic Conditions in Pregnant Women in the East African Setting, a Pilot Study

Annals of Global Health ◽

10.1016/j.aogh.2017.03.228 ◽

2017 ◽

Vol 83 (1) ◽

pp. 102

Author(s):

B.C.H. Griffith ◽

I. Namagembe ◽

A. Nakimuli ◽

N. Basta

Keyword(s):

Pilot Study ◽

Pregnant Women ◽

Emergency Care ◽

Care Seeking ◽

East African ◽

African Setting

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Features of primary care practice influence emergency care-seeking behaviors by caregivers of persons with dementia: A multiple-perspective qualitative study

Dementia ◽

10.1177/1471301220905233 ◽

2020 ◽

pp. 147130122090523

Author(s):

Aaron P Beck ◽

Gwen C Jacobsohn ◽

Matthew Hollander ◽

Andrea Gilmore-Bykovskyi ◽

Nicole Werner ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Emergency Care ◽

Primary Care Practice ◽

Care Practice ◽

Care Seeking ◽

Multiple Perspective

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Applying the Three Delays Model to understand emergency care seeking and delivery in rural Bangladesh: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2020-042690 ◽

2020 ◽

Vol 10 (12) ◽

pp. e042690

Author(s):

Bansari Shah ◽

Nandita Krishnan ◽

Stephen R. Kodish ◽

Gayane Yenokyan ◽

Kaniz Fatema ◽

...

Keyword(s):

Focus Group ◽

Emergency Care ◽

Healthcare Providers ◽

Care Seeking ◽

Community Members ◽

Focus Group Discussions ◽

Group Discussions ◽

Rural Bangladesh ◽

Three Delays ◽

Depth Interviews

ObjectivesThe Three Delays Model has been commonly used to understand and prevent maternal mortality but has not been systematically applied to emergency medical conditions more generally. The objective of this study was to identify delays in emergency medical care seeking and delivery in rural Bangladesh and factors contributing to these delays by using the Three Delays Model as a framework.DesignA qualitative approach was used. Data were collected through focus group discussions and in-depth interviews using semistructured guides. Two analysts jointly developed a codebook iteratively and conducted a thematic analysis to triangulate results.SettingSix unions in Raiganj subdistrict of Bangladesh.ParticipantsEight focus group discussions with community members (n=59) and eight in-depth interviews with healthcare providers.ResultsDelays in the decision to seek care and timely receipt of care on reaching a health facility were most prominent. The main factors influencing care-seeking decisions included ability to recognise symptoms and decision-making power. Staff and resource shortages and lack of training contributed to delays in receiving care. Delay in reaching care was not perceived as a salient barrier. Both community members and healthcare providers expressed interest in receiving training to improve management of emergency conditions.ConclusionsThe Three Delays Model is a practical framework that can be useful for understanding barriers to emergency care and developing more tailored interventions. In rural Bangladesh, training community members and healthcare providers to recognise symptoms and manage acute conditions can reduce delays in care seeking and receiving adequate care at health facilities.

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Delayed emergency healthcare seeking behaviour by Dutch emergency department visitors during the first COVID-19 wave: a mixed methods retrospective observational study

BMC Emergency Medicine ◽

10.1186/s12873-021-00449-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maaike Nab ◽

Robyn van Vehmendahl ◽

Inne Somers ◽

Yvonne Schoon ◽

Gijs Hesselink

Keyword(s):

Emergency Department ◽

Emergency Care ◽

Care Seeking ◽

Online Questionnaire ◽

Healthcare Seeking ◽

Telephone Interviews ◽

Ed Visits ◽

Reported Data ◽

Reporting Delay ◽

Care Seeking Behaviour

Abstract Background Emergency department (ED) visits due to non-coronavirus disease 2019 (COVID-19) conditions have drastically decreased since the outbreak of the COVID-19 pandemic. This study aimed to identify the magnitude, characteristics and underlying motivations of ED visitors with delayed healthcare seeking behaviour during the first wave of the pandemic. Methods Between March 9 and July 92,020, adults visiting the ED of an academic hospital in the East of the Netherlands received an online questionnaire to collect self-reported data on delay in seeking emergency care and subsequent motivations for this delay. Telephone interviews were held with a subsample of respondents to better understand the motivations for delay as described in the questionnaire. Quantitative data were analysed using descriptive statistics. Qualitative data were thematically analysed. Results One thousand three hundred thirty-eight questionnaires were returned (34.0% response). One in five respondents reported a delay in seeking emergency care. Almost half of these respondents (n = 126; 45.4%) reported that the pandemic influenced the delay. Respondents reporting delay were mainly older adults (mean 61.6; ±13.1 years), referred to the ED by the general practitioner (GP; 35.1%) or a medical specialist (34.7%), visiting the ED with cardiac problems (39.7%). The estimated median time of delay in receiving ED care was 3 days (inter quartile range 8 days). Respectively 46 (16.5%) and 26 (9.4%) respondents reported that their complaints would be either less severe or preventable if they had sought for emergency care earlier. Delayed care seeking behaviour was frequently motivated by: fear of contamination, not wanting to burden professionals, perceiving own complaints less urgent relative to COVID-19 patients, limited access to services, and by stay home instructions from referring professionals. Conclusions A relatively large proportion of ED visitors reported delay in seeking emergency care during the first wave. Delay was often driven by misperceptions of the accessibility of services and the legitimacy for seeking emergency care. Public messaging and close collaboration between the ED and referring professionals could help reduce delayed care for acute needs during future COVID-19 infection waves.

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What does the ideal urgent and emergency care system look like? A qualitative study of service user perspectives

Emergency Medicine Journal ◽

10.1136/emermed-2019-208921 ◽

2020 ◽

Vol 37 (4) ◽

pp. 200-205

Author(s):

Suzanne Ablard ◽

Maxine Kuczawski ◽

Fiona C Sampson ◽

Suzanne M Mason

Keyword(s):

Focus Groups ◽

Emergency Care ◽

Health Professionals ◽

Service User ◽

Single Point ◽

Health Staff ◽

Service Users ◽

Care Seeking ◽

Long Term Conditions ◽

The Ideal

BackgroundPolicies aimed at diverting care from EDs to alternative services have not been successful in reducing ED attendances and have contributed to confusion for service users when making care-seeking decisions. It is important that service users are at the heart of decision making to ensure new services meet the needs of those who will be accessing them. In this study, service users were encouraged to think freely about the desirable qualities of an ideal urgent and emergency care (UEC) system.MethodsFrom September to February 2019, an open inductive methodology was used to conduct focus groups with service users who had used UK UEC services within the previous year. Service users that had contact with NHS111, ambulance service, General Practice out-of-hours, minor injuries unit, walk-in centre or ED were purposively sampled and stratified into the following groups: (1) 18–45 years; (2)≥75 years; (3) adults with young children; (4) adults with long-term conditions. Focus groups were structured around experiences of accessing UEC services and perspectives of an ‘ideal’ UEC system.Results30 service users took part in the study, across four focus groups. The ideal UEC system centred around three themes: a simplified UEC system (easier to understand and a single-point of access); more ‘joined-up’ UEC services and better communication between health staff and patients.ConclusionDesirable qualities of an ideal UEC system from a service user perspective related to simplifying access for example, through a single point of access system where health professionals decide the appropriate service required and improving continuity of care through better integration of UEC services. Service users value reassurance and communication from health professionals about care pathways and care choices, and this helps service users feel more in control of their healthcare journey.

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