You are here

Article Text

Article menu
Health services research
Original research
Impact of COVID-19 on emergency department attendance in an Australia hospital: a parallel convergent mixed methods study
  1. Rebecca Leigh Jessup1,2,3,4,5,
  2. C Bramston2,
  3. A Beauchamp3,6,
  4. A Gust4,
  5. N Cvetanovska3,
  6. Y Cao7,
  7. C Haywood4,8,
  8. P Conilione4,
  9. Mark Tacey9,
  10. Beverley Copnell10,
  11. H Mehdi9,
  12. Dialla Alnasralah9,
  13. M Kirk11,
  14. Emilliano Zucchi12,
  15. D Campbell4,13,
  16. A Trezona14,
  17. T Haregu7,
  18. Brian Oldenburg7,
  19. K Stockman4,13,
  20. Adam Ivan Semciw1,2,5
  1. 1Academic and Research Collaborative in Health (ARCH), La Trobe University, Melbourne, Victoria, Australia
  2. 2Allied Health, Northern Health, Epping, Victoria, Australia
  3. 3School of Rural Health, Monash University, Warrigal, Victoria, Australia
  4. 4Staying Well and Hospital Without Walls Program, Northern Health, Epping, Victoria, Australia
  5. 5School of Allied Health, Human Services and Sport, LaTrobe University, Bundoora, Victoria, Australia
  6. 6Department of Medicine - Western Health, The University of Melbourne, St Albans, Victoria, Australia
  7. 7School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  8. 8Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
  9. 9Office of Research, Northern Health, Epping, Victoria, Australia
  10. 10School of Nursing and Midwifery, LaTrobe University, Melbourne, Victoria, Australia
  11. 11Department of Medicine, Rockhampton Hospital, Rockhampton, Queensland, Australia
  12. 12Transcultural and Language Services, Northern Health, Melbourne, Victoria, Australia
  13. 13Faculty of Art, Design and Architecture, Monash University, Clayton, Victoria, Australia
  14. 14Trezona Consulting Group, Brunswick, Victoria, Australia
  1. Correspondence to Dr Rebecca Leigh Jessup; rebecca.jessup{at}nh.org.au

Abstract

Objectives The COVID-19 pandemic has changed the way people are accessing healthcare. The aim of this study was to examine the impact of COVID-19 on emergency department (ED) attendance for frequent attenders and to explore potential reasons for changes in attendance.

Design This convergent parallel mixed methods study comprised two parts.

Setting An interrupted time-series analysis evaluated changes in ED presentation rates; interviews investigated reasons for changes for frequent ED users in a culturally and linguistically diverse setting.

Participants A total of 4868 patients were included in the time series. A subgroup of 200 patients were interviewed, mean age 66 years (range 23–99).

Results Interrupted time-series analysis from 4868 eligible participants showed an instantaneous decrease in weekly ED presentations by 36% (p<0.001), with reduction between 45% and 67% across emergency triage categories. 32% did not know they could leave home to seek care with differences seen in English versus non-English speakers (p<0.001). 35% reported postponing medical care. There was a high fear about the health system becoming overloaded (mean 4.2 (±2) on 6-point scale). Four key themes emerged influencing health-seeking behaviour: fear and/or avoidance of hospital care; use of telehealth for remote assessment; no fear or avoidance of hospital care; not leaving the house for any reason.

Conclusions This study demonstrated reduced ED use by a vulnerable population of previously frequent attenders. COVID-19 has resulted in some fear and avoidance of hospitals, but has also offered new opportunity for alternative care through telehealth.

  • COVID-19
  • organisation of health services
  • public health

Data availability statement

Data are available upon reasonable request. De-identified participant data from this research will be shared upon reasonable request with the corresponding author.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2021-049222

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available upon reasonable request. De-identified participant data from this research will be shared upon reasonable request with the corresponding author.

    View Full Text

    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Footnotes

    • Contributors The author and overall design was conceived and planned by RLJ, AB and AIS. The work was operationalised (protocol development, ethics application) by RLJ and CB. RLJ, CB, NC, DA, HM, YC, AG and TH conducted the data collection. AIS, AG, MT, RLJ and PC conducted the quantitative analysis and RLJ, CH, AT and AB conducted the qualitative analysis. RLJ wrote the first draft of the manuscript and all authors contributed to the analysis strategy and all drafts (RLJ, CB, AB, AG, NC, YC, CH, PC, MT, BC, MH, CA, MK, EZ, DC, AT, TH, BO, KS, AIS). All authors contributed to the interpretation of the results. All authors critically reviewed the manuscript and approved the final version. RLJ is the overall content guarantor and accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding This study was supported by the Northern Health Research Foundation grant number 24-2020; the Inner North West, Health West and Hume Whittlesea Primary Care Partnerships (not a competitive grant); and La Trobe University Northern Academic and Research Collaborative in Health (not a competitive grant). This research was conducted independent of all funders.

    • Competing interests All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three year, no other relationships or activities that could appear to have influenced the submitted work.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.