Evaluation of the factors associated with inappropriate use of the emergency department at King Fahd Hospital, Jeddah City, and the role of primary care

Problem

Citizens in Saudi Arabia are expected to enjoy free and unlimited health care but there are several accessibility challenges. One major challenge is that many patients visit directly the emergency departments (ED) of hospitals although their health issues could be treated at primary health care centres (PHCC). The over-presentation of Saudi patients in ED impacts on health care efficiency because available PHCC services are underused whereas expensive ED services are overused. This research aims to understand why patients who could be treated in PHCC inappropriately seek care at ED in Saudi Arabia.

Approach

A cross-sectional survey was undertaken in the King Fahd Hospital and three of its associated PHCCs in Jeddah city. The main inclusion criteria for this study is adult patients attending the PHCCs and adult patients presenting in ED with non-urgent health problems (which are treatable in PHCCs). All participants in PHCCs and ED were interviewed using structured questionnaires specifically devised for the purposes of this study. Anonymised data was analysed using the SSPS software.

Findings

I recruited 410 adult patients, with males comprising 51.0% of the sample. A significantly high proportion of patients with non-urgent cases visited the ED in compare to PHCCs not married (64.9%), at younger age (62.5%), with lower education (56.4%), and lower income (72.2%). A significantly higher proportion of patients without emergencies did not suffer from any chronic diseases, and most of them lacked of health insurance while some of them worked for private sector. Most patients without emergencies thought the ED was the first place to consult when they felt symptoms as they lacked the knowledge of PHCCs clinics and services. A significantly higher percentage of ED attendees for non-urgent cases did not know the opening hours of PHCC in their neighbourhood. A significantly high percentage of ED attendees reported that their decision to visit ED without emergences was influenced by family or friends, and most of them were not registered with PHCC. A significantly higher proportion of ED attendees reported that they get better services at ED in compare to PHCCs services. These patients reported difficulties of getting appointments, communication with their PHCC physician, unavailability of investigation services, shortage of some medication, and visiting a different physician each time. Patients were more satisfied with PHCCs when their physician provided preventive counselling. The general satisfaction of PHCCs attendees were higher than ED attendees regarding PHCCs services.

Consequences

The planned study specifically examines whether there are differences in the characteristics, knowledge, attitudes and satisfaction of patients presenting in PHCC compared to patients who present in ED but could be treated in PHCC. The goal of this study is to identify factors that could be used by policy makers in Saudi Arabia to improve the usage of PHCC and the use of ED.