Abstract
Background: The use of emergency department (ED) services for non-urgent conditions is well-studied in many Western countries but much less so in the Middle East and Gulf region. While the consequences are universal—a drain on ED resources and poor patient outcomes—the causes and solutions are likely to be region and country specific. Unique social and economic circumstances also create gender-specific motivations for patient attendance. Alleviating demand on ED services requires understanding these circumstances, as past studies have shown. We undertook this study to understand why female patients with low-acuity conditions choose the emergency department in Qatar over other healthcare options. Setting and design: Prospective study at Hamad General Hospital's (HGH) emergency department female “see-and-treat” unit that treats low-acuity cases. One hundred female patients were purposively recruited to participate in the study. Three trained physicians conducted semi-structured interviews with patients over a three-month period after they had been treated and given informed consent. Results: The study found that motivations for ED attendance were systematically influenced by employment status as an expatriate worker. Forty percent of the sample had been directed to the ED by their employers, and the vast majority (89%) of this group cited employer preference as the primary reason for choosing the ED. The interviews revealed that a major obstacle to workers using alternative facilities was the lack of a government-issued health card, which is available to all citizens and residents at a nominal rate. Conclusion: Reducing the number of low-acuity cases in the emergency department at HGH will require interventions aimed at encouraging patients with non-urgent conditions to use alternative healthcare facilities. Potential interventions include policy changes that require employers to either provide workers with a health card or compel employees to acquire one for themselves.
Highlights
Much less is known about emergency department (ED) utilization in the Middle East and North Africa, areas of the world that have diverse populations with unique sociocultural values that likely contribute to different patterns in patient attendance and use
55 and older responses to question #4 on Appendix A: 1) better/faster care; 2) ease of accessibility; 3) lack of knowledge of other facilities; 4) lack of health card/cost; 5) and employer preference. We used these codes to determine whether and how patterns in ED attendance varied across demographic subgroups, as we describe in the Results section below
Future research should examine the degree to which these findings differ for male patients in Qatar, the vast majority of whom are foreign laborers. Such a study could further help inform policies aimed at improving the quality of patient care, both in Qatar and in other countries with large populations of expatriate workers. This was the first study to examine motivations for ED attendance in Qatar and the findings indicate different patterns than those found in Western nations.[1,2,3,20]
Summary
Increasing demand for emergency department (ED) services is a worldwide phenomenon that has been well-studied in many Western and developed countries, such as the United Kingdom and United States.[1,2,3,4,5] Much less is known about ED utilization in the Middle East and North Africa, areas of the world that have diverse populations with unique sociocultural values that likely contribute to different patterns in patient attendance and use.
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