Delayed emergency healthcare seeking behaviour by Dutch emergency department visitors during the first COVID-19 wave: a mixed methods retrospective observational study

Abstract

Background Emergency 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. Methods Between 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. Results One 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. Conclusions A 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.

Increase in Anxiety-Related Out-of-Hours Primary Care Consultations Since COVID-19: An Observational Study Using Routine Data in Flanders

“…These findings contrast with the general pattern of a decline in healthcare seeking behavior for primary and acute care during this phase of the pandemic, in Belgium as in the rest of the world (5,(8)(9)(10). While contacts for general health or emergency care declined, the number of OOH contacts for mental health problems rose.…”

Impact of two waves of Sars‐Cov2 outbreak on the number, clinical presentation, care trajectories and survival of patients newly referred for a colorectal cancer: A French multicentric cohort study from a large group of university hospitals

“…Scientific societies issued guidelines for adapting care strategies to the situation of the pandemic 7,8 . The reallocation of doctors from various specialties to temporary units dedicated to Sars‐Cov2 patients and the modifications to treatment pathways could have disrupted the timelines of cancer care and the course of treatment chosen for patients 9‐11 …”

“…7,8 The reallocation of doctors from various specialties to temporary units dedicated to Sars-Cov2 patients and the modifications to treatment pathways could have disrupted the timelines of cancer care and the course of treatment chosen for patients. [9][10][11] This situation raised multiple hypotheses about the impact of the Sars Cov2 pandemic on CRC care. Previous evidence shows that the outbreak-related policies have induced delays in CRC diagnostic procedures, but these policies may have also increased time-totreatment after diagnosis.…”

Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review

“…Likewise, one of the individual characteristics that has been most influential in terms of new barriers created by the pandemic is fear of contagion [83][84][85][86]88,89,94,95,97], an aspect that has been discussed in many publications, including opinion articles [113,[137][138][139][140][141][142], and also played a highly significant role in previous epidemics as a factor causing problems or delays in seeking medical care [2,21,24,26,72,76,101,108,143,144]. Other factors reported include the stigma associated with seeking care [84,89,93,94,97], also described in other publications [109,145], and users playing down the need for medical treatment [84,94,98] and perceiving a lack of response on the part of the health services [85,88].…”