Predictors of non-urgent utilization of hospital emergency services in Kuwait

doi:10.1016/0277-9536(95)00233-2

Social Science & Medicine

Volume 42, Issue 9, May 1996, Pages 1313-1323

https://doi.org/10.1016/0277-9536(95)00233-2 Get rights and content

Abstract

Utilization of the emergency rooms (ERs) in Kuwait has increased considerably during the last decade. Such an increase is a concern for health planners because of the burden on ER services, lack of continuous service provided by the ER and the higher cost of such services. Based on a study of 2011 patients attending the medical ERs in the six government hospitals in early 1993, the predictors of non-urgent utilization were analyzed. Patients were asked about their reasons for visiting the ER rather than the primary health care (PHC) centre. Both patients and doctors were asked to rate the urgency of the visit.

According to the doctors' judgment, 61% of the visits were for non-urgent problems that did not require emergency care, while 23% of the patients viewed their visits to be non-urgent. Multiple logistic regression analysis indicated that perceived urgency of the visit was the most important predictor of a non-urgent visit to the ER, after controlling for several predisposing and enabling factors. Patients who perceived their visit to the ER to be non-urgent were about four times more likely to visit the ER for a non-urgent condition as judged by the doctor.

The level of education had a significant, positive effect on non-urgent utilization among both Kuwaiti nationals and expatriates. Several factors may explain the above finding. Employment of educated persons in the hospital was one route through which education facilitated ER use. It is also likely that educated persons had more influential contacts or wasta in the hospital. Also, the less educated might have delayed seeking care while the educated consulted for non-urgent reasons as soon as they noticed the symptoms. Like education, the level of non-urgent utilization was higher among Kuwaiti nationals with higher incomes. Thus, a higher social class seems to facilitate ER use for non-urgent reasons. Among the non-Kuwaitis, lack of registration at the PHC centre was a significant reason for non-urgent use of the ER.

It is recommended that hurdles in the utilization of PHC facilities should be removed. Registration of non-Kuwaitis at the PHC must be improved, and referrals to the PHC back from the ER should be instituted to ensure the necessary follow-up care.

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Predictors of non-urgent utilization of hospital emergency services in Kuwait

Abstract

Soc. Sci. Med.

Soc. Sci. Med.

Ann. Emerg. Med.

J. Emerg. Med.

Ann. Emerg. Med.

Soc. Sci. Med.

A rural emergency department

West J. Med.

Patchwork access

Primary care in EDs on the rise

Am. Hosp. Ass.

Excessive utilization of hospital emergency services in pre-occupation Kuwait: trends and differentials

Med. Principals Pract.

Societal and individual determinants of medical care in the United States

Milbank Q.

Process model of seeking mental health services: proposed framework for organizing the research literature on help-seeking

Non emergency emergency room use in patients with and without primary care physicians

J. Fam. Pract.

Emergency room use and abuse

How it varies with payment mechanism

Minn. Med.

Social class and medical care: indices of non urgency in use of hospital emergency services

Med. Care

Parental perception of urgency and utilization of pediatric emergency services

Fam. Pract. Res. J.

An emergency room's patients: their characteristics and utilization of hospital services

Med. Care

Careseeking patterns of families using a municipal hospital emergency room

Med. Care