Abstract

BackgroundEmergency 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.MethodsBetween 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.ResultsOne 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.ConclusionsA 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.

Highlights

  • IntroductionAs COVID-19 made its way across the globe, another worrying trend evolved, namely the rapid decline of emergency admissions since the start of the pandemic for non-COVID-19 related health issues such as chest pain, acute coronary syndrome (ACS) or appendicitis [2,3,4,5,6,7]

  • Emergency department (ED) visits due to non-coronavirus disease 2019 (COVID-19) conditions have drastically decreased since the outbreak of the COVID-19 pandemic

  • 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

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Summary

Introduction

As COVID-19 made its way across the globe, another worrying trend evolved, namely the rapid decline of emergency admissions since the start of the pandemic for non-COVID-19 related health issues such as chest pain, acute coronary syndrome (ACS) or appendicitis [2,3,4,5,6,7] This decline can be partially explained by the downscaling of regular care and a less active society, case reports and observational studies show that patients are less likely to seek emergency healthcare in fear of contracting COVID-19 [8, 9]. Medical care delay or avoidance might exacerbate health problems and increase mortality risk associated with treatable and preventable health conditions [9, 10]

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