Reasons for patients with non-urgent conditions attending the emergency department in Kenya: A qualitative study

Matifary, Caroline R.; Wachira, Benjamin; Nyanja, Njeri; Kathomi, Caroline

doi:10.1016/j.afjem.2020.09.004

Cited by 6 publications

(10 citation statements)

References 22 publications

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“…Many patients described having feelings of anxiety, uncertainty or significant concern about their health problem [ 22 , 45 , 65 , 70 , 88 , 92 – 95 ]. Often patients had experienced pain or other discomforts which impacted their function and they desired immediate relief [ 22 , 42 , 45 , 70 – 73 , 88 , 93 , 94 , 96 , 97 ]. In some cases, they had attempted self-treatment at home, without good effect [ 73 , 86 , 96 , 98 ], or had sought out primary care without resolve [ 21 , 42 , 53 , 66 , 74 , 75 , 88 , 92 ].…”

Section: Resultsmentioning

confidence: 99%

“…In some cases, they had attempted self-treatment at home, without good effect [ 73 , 86 , 96 , 98 ], or had sought out primary care without resolve [ 21 , 42 , 53 , 66 , 74 , 75 , 88 , 92 ]. Even when patients knew their condition was non-urgent, they still wanted reassurance, advice, or a second opinion [ 26 , 33 , 37 , 43 , 44 , 48 , 53 , 55 , 56 , 64 , 69 , 72 , 88 , 94 , 97 ]. One study found that patients had a self-perceived inability to cope [ 88 ].…”

Section: Resultsmentioning

confidence: 99%

“…They could not obtain a PCP appointment at all [ 17 , 20 , 21 , 27 , 28 , 33 , 35 , 36 , 66 , 69 , 79 , 80 , 92 , 93 , 98 , 99 ], or they could not obtain an appointment that did not interfere with work/school [ 46 , 54 , 66 , 73 , 93 , 96 , 101 ], or childcare [ 96 ]. There were significant issues obtaining care after hours or as a result of limited hours provided by the PCP [ 16 , 19 , 22 , 28 , 33 , 35 – 37 , 41 , 44 , 47 – 50 , 54 , 56 , 57 , 66 , 72 , 74 , 85 , 87 , 92 , 94 , 97 – 99 , 101 – 103 ]. Some patients were not registered with a PCP [ 18 , 25 , 27 , 29 , 30 , 35 , 36 , 43 , 49 , 54 , 55 , 58 , 61 , 62 , 64 , 66 ,…”

Section: Resultsmentioning

confidence: 99%

“…There were significant issues obtaining care after hours or as a result of limited hours provided by the PCP [ 16 , 19 , 22 , 28 , 33 , 35 – 37 , 41 , 44 , 47 – 50 , 54 , 56 , 57 , 66 , 72 , 74 , 85 , 87 , 92 , 94 , 97 – 99 , 101 – 103 ]. Some patients were not registered with a PCP [ 18 , 25 , 27 , 29 , 30 , 35 , 36 , 43 , 49 , 54 , 55 , 58 , 61 , 62 , 64 , 66 , 77 ] or there were no primary care options at all [ 26 , 28 , 45 , 46 , 54 , 62 , 66 , 70 , 90 , 92 , 96 , 97 , 102 ]. A large majority of patients felt that it took too long to wait for an appointment with the PCP, even if they were successful in scheduling one [ 20 , 21 , 24 , 25 , 36 , 37 , 48 , 49 , 53 ,…”

Section: Resultsmentioning

confidence: 99%

“…A large number patients reported that the ED afforded them superior care, beyond what could be obtained in primary care. Patients believed ED care was of higher quality and as such, they had greater trust and confidence in the ED [ 18 , 19 , 21 , 22 , 27 , 30 – 33 , 37 , 39 , 41 – 48 , 54 , 56 , 58 , 61 – 65 , 74 – 79 , 83 , 84 , 87 , 94 , 97 , 98 , 103 ]. Investigations were perceived to be more thorough [ 21 , 35 , 77 , 78 , 92 , 103 ], with all resources available in one location [ 18 , 22 , 26 , 28 , 33 , 37 , 40 , 45 , 48 , 56 , 66 , 82 , 86 , 93 – 95 , 97 , 98 , 100 ].…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

An integrative review of adult patient-reported reasons for non-urgent use of the emergency department

McIntyre

Janzen²,

Shepherd

et al. 2023

BMC Nurs

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Objective To conduct an integrative review of the scientific literature to explore adult patient-reported reasons for using the emergency department (ED) non-urgently. Method A literature search of CINAHL, Cochrane, Embase, PsycINFO, and MEDLINE was conducted with filters for humans, published January 1, 1990-September 1, 2021, and English language. Methodological quality was assessed using Critical Appraisal Skills Programme Qualitative Checklist for qualitative and National Institutes Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies for quantitative studies. Data was abstracted on study and sample characteristics, and themes/reasons for ED use. Cited reasons were coded using thematic analysis. Results Ninety-three studies met inclusion criteria. Seven themes were found: need to be risk averse with respect to the health issue; knowledge and awareness of alternative sources of care; dissatisfaction with primary care provider; satisfaction with ED; ED accessibility and convenience resulting in low access burden; referred to the ED by others; and relationships between patients and health care providers. Discussion This integrative review examined patient-reported reasons for attending the ED on a non-urgent basis. The results suggest that ED patients are heterogenous and many factors influence their decision-making. Considering the complexity with which patients live, treating them as a single entity may be problematic. Limiting excessive non-urgent visits likely requires a multi-pronged approach. Conclusion For many ED patients, they have a very clear problem which needed to be addressed. Future studies should explore psychosocial factors driving decision-making (e.g., health literacy, health-related personal beliefs, stress and coping ability).

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

An integrative review of adult patient-reported reasons for non-urgent use of the emergency department

McIntyre

Janzen²,

Shepherd

et al. 2023

BMC Nurs

View full text Add to dashboard Cite

show abstract

Health anxiety and oppressive support: their impact on decisions for non-urgent use of the emergency department of obstetrics and gynecology

Mazzoni,

Amadori,

Sebri

et al. 2023

Curr Psychol

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The high number of non-urgent visits to the emergency departments of obstetrics and gynecology (EDOG) is receiving increasing attention from researchers and public health professionals. The decision to access the EDOG is the result of a decision-making process based on three phases, from the problem recognition to the intention to seek medical care, and the decision to visit the EDOG. Each stage may depend on different psychological and social factors, but their specific role is still unclear. The aim of this study was to investigate the psychological and social factors which are implied in the decision-making process leading to non-urgent visits to the emergency department. A questionnaire was administered to 280 women between the 10th and the 14th week of pregnancy. Results showed that health anxiety had a positive effect on all three stages of the decision-making process (problem recognition, seeking medical care, and visiting the emergency department). Satisfaction with the prenatal care service showed a positive effect on the first two stages, while oppressive support had a positive effect on visiting the emergency department. We suggest that educational interventions for patients and family members aimed at reducing health anxiety and oppressive support during pregnancy could reduce the number of inappropriate accesses to the emergency department, with a beneficial effect on its functioning, patient-and-caregiver relationship, and the healthcare system costs.

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Emergency departments as under-utilized venues to provide HIV prevention services to female sex workers in Nairobi, Kenya

et al. 2023

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Background Female sex workers (FSW) in sub-Saharan Africa are disproportionately affected by HIV and remain a key target population for efforts to reduce transmission. While HIV prevention tools such as PEP and PrEP are available through outpatient FSW clinics, these services are underused. Emergency medicine is a rapidly expanding field in Kenya and may provide a novel venue for initiating or optimizing HIV prevention services. This study examined the characteristics of FSW from Nairobi, Kenya, who had utilized an emergency department (ED) during the past year to broaden our understanding of the patient factors related to usage. Methods An anonymous questionnaire was administered to a convenience sample of 220 Nairobi FSW attending dedicated clinics from June to July 2019. The participants were categorized into those who attended an ED over the past year (acute care users) and clinic-only users (control). A modified version of the WHO Violence Against Women Instrument assessed gender-based violence. Multivariable negative binomial logistic regressions evaluated predictors of health care use among these populations. Results Of the total 220 women (median [IQR] age 32 [27–39]), 101 and 116 were acute care and control populations, respectively. Acute care users had 12.7 ± 8.5 healthcare visits over a 12-month period, and the control population had 9.1 ± 7.0 (p < 0.05). ED attendance did not improve the PrEP usage, with 48.5%, and 51% of acute care and clinic users indicated appropriate PrEP use. Patient factors that correlated with health care utilization among acute care users included client sexual violence (OR 2.2 [1.64–2.94], p < 0.01), PrEP use (OR 1.54 (1.25–1.91), < 0.01), and client HIV status (OR 1.35 (1.02–1.69), p < 0.01). Conclusions Many FSW at high risk for HIV were not accessing HIV prevention tools despite attending a dedicated FSW clinic offering such services. FSW who had attended an ED over the past year had a higher prevalence of HIV risk factors, demonstrating that emergency departments may be important acute intervention venues to prevent HIV transmission in this population. These results can guide policy design, health care provider training, and facility preparedness to support strategies aimed at improving HIV prevention strategies for FSW in Kenyan ED’s.

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Reasons for patients with non-urgent conditions attending the emergency department in Kenya: A qualitative study

Cited by 6 publications

References 22 publications

An integrative review of adult patient-reported reasons for non-urgent use of the emergency department

An integrative review of adult patient-reported reasons for non-urgent use of the emergency department

Health anxiety and oppressive support: their impact on decisions for non-urgent use of the emergency department of obstetrics and gynecology

Emergency departments as under-utilized venues to provide HIV prevention services to female sex workers in Nairobi, Kenya

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