Emergency Department Utilization for Patients Living With Sickle Cell Disease: Psychosocial Predictors of Health Care Behaviors

Abstract

Individuals living with sickle cell disease (SCD) often require urgent care; however, some patients hesitate to present to the emergency department (ED), which may increase the risk of serious clinical complications. Our study aims to examine psychosocial, clinical, and demographic factors associated with delaying ED care. Methods: This was a cross-sectional study of 267 adults with SCD from the national INSIGHTS Study. The binary outcome variable asked whether, in the past 12 months, participants had delayed going to an ED when they thought they needed care. Logistic regression was performed with clinical, demographic, and psychosocial measures. Results: Approximately 67% of the participants reported delaying ED care. Individuals who delayed care were more likely to have reported higher stigma experiences (odds ratio [OR]¼1.09; 95% confidence interval [CI] 1.03 to 1.16), more frequent pain episodes (OR¼1.15; 95% CI 1.01 to 1.32), lower health care satisfaction (OR¼ 0.74; 95% CI 0.59 to 0.94), and more frequent ED visits (OR¼6.07; 95% CI 1.18 to 31.19). Disease severity and demographics, including sex, age, and health insurance status, were not significantly associated with delay in care. Conclusion: Psychosocial factors, including disease stigma and previous negative health care experiences, are associated with delay of ED care in this SCD cohort. There is a need to further investigate the influence of psychosocial factors on the health careseeking behaviors of SCD patients, as well as the downstream consequences of these behaviors on morbidity and mortality. The resulting knowledge can contribute to efforts to improve health care experiences and patient-provider relationships in the SCD community. [

Healthcare utilization and the quality of life of children and adolescents with sickle cell disease

“…Overall, this study highlights the role increased healthcare utilization plays in predicting the HRQOL of youth diagnosed with SCD. Empirical evidence suggests that factors such as pain lead to increased healthcare use, 5 and findings from this study note how age is a predictor as well. The illness intrusiveness theory may explain this relationship and provide implications for healthcare professionals.…”

“…Sickle cell disease (SCD) is a hemoglobinopathy caused by a point mutation in the beta globin gene that can alter the normal biconcave disk shape of the red blood cell (RBC) into a sickle shape at a steady state and for several reasons such as stress, infection, and inflammation 1,2 . The sickling process results in chronic vascular damage that may cause organ damage, infection, acute chest, and pain, 3,4 which are common reasons patients with SCD may access the hospital setting for treatment 5,6 …”

“…1,2 The sickling process results in chronic vascular damage that may cause organ damage, infection, acute chest, and pain, 3,4 which are common reasons patients with SCD may access the hospital setting for treatment. 5,6 Healthcare utilization among individuals with SCD is increasing, along with the associated costs. The annual healthcare cost of managing individuals with SCD ranges from $18 859 for ages 0-9 years old to $43 586 for ages 20-29 years old.…”

Behavioural drivers influencing emergency department attendance in Victoria during the 2020 COVID‐19 pandemic: A mixed methods investigation

“…Patient behaviours relating to ED attendance can be influenced by factors unrelated to illness. Previous experience with ED care 11 and pre‐existing sociodemographic, socioeconomic and psychosocial factors 12–15 appear to be important. External factors such as the time of day, season and weather conditions also play a role 16–18 .…”

End the pain: Start with antiracism

“…Nearly 70% of patients with SCD avoid seeking medical help during vasoocclusive crisis despite its incapacitating nature. 10 Many patients with SCD are reluctant to access care for the key reason that they fear poor treatment and dismissal of their experience, a scenario poignantly depicted in the Lenox Hill episode. If you are a patient with SCD, it is exceedingly difficult to approach a physician if you are unsure that the physician will believe your pain and act as your ally.…”