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Sociodemographic and clinical factors, visit expectations and driving factors for emergency department attendance for uncomplicated upper respiratory tract infection
  1. Angela Chow1,2,3,
  2. Bryan Keng1,
  3. Huiling Guo1,
  4. Aung Hein Aung1,
  5. Zhilian Huang1,
  6. Yanyi Weng4,
  7. Hou Ang4
  1. 1 Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
  2. 2 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
  3. 3 Saw Swee Hock School of Public Health, National University of Singapore, Singapore
  4. 4 Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore
  1. Correspondence to Dr Angela Chow, Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore 308433, Singapore; angela_chow{at}


Background Upper respiratory tract infections (URTIs) account for substantial non-urgent ED attendances. Hence, we explored the reasons for such attendances using a mixed-methods approach.

Methods We interviewed adult patients with URTI who visited the second busiest adult ED in Singapore from June 2016 to November 2018 on their expectations and reasons for attendance. A structured questionnaire, with one open-ended question was used. Using the Andersen’s Behavioural Model for Healthcare Utilisation, the topmost reasons for ED attendances were categorised into (1) contextual predisposing factors (referral by primary care physician, family, friends or coworkers), (2) contextual enabling factors (convenience, accessibility, employment requirements), (3) individual enablers (personal preference and trust in hospital-perceived care quality and efficiency) and (4) individual needs (perceived illness severity and non-improvement). Multivariable multinomial logistic regression was used to assess associations between sociodemographic and clinical factors, patient expectations for ED visits and the drivers for ED attendance.

Results There were 717 patients in the cohort. The mean age of participants was 40.5 (SD 14.7) years, 61.2% were males, 66.5% without comorbidities and 40.7% were tertiary educated. Half had sought prior medical consultation (52.4%) and expected laboratory tests (55.7%) and radiological investigations (46.9%). Individual needs (32.8%) and enablers (25.1%) were the main drivers for ED attendance. Compared with ED attendances due to contextual enabling factors, attendances due to other drivers were more likely to be aged ≥45 years, had prior medical consultation and expected radiological investigations. Having a pre-existing medical condition (adjusted OR (aOR) 1.78, 95% CI 1.05 to 3.04) and an expectation for laboratory tests (aOR 1.64, 95% CI 1.01 to 2.64) were associated with individual needs while being non-tertiary educated (aOR 2.04, 95% CI 1.22 to 3.45) and having pre-existing comorbidities (aOR 1.79, 95% CI 1.04 to 3.10) were associated with individual enablers.

Conclusions Meeting individual needs of perceived illness severity or non-improvement was the topmost driver of ED visits for URTI, while contextual enabling factors such as convenience was the lowest. Patients’ sociodemographic and clinical factors and visit expectations influence their motivations for ED attendances. Addressing these factors and expectations can alleviate the overutilisation of ED services.

  • utilisation
  • emergency department
  • infections
  • viral

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Handling editor Ellen J Weber

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  • Contributors AC conceived and designed the study, and obtained research funding. AC supervised the conduct of the study and data collection. AC, HG and ZH provided statistical oversight to the study. AC, BK, AHA and HG analysed the data. AC and BK drafted the manuscript, and all authors contributed substantially to its revision. AC and HA take responsibility for the paper as a whole.

  • Funding This work was supported by the National Healthcare Group Singapore’s Clinician Scientist Career Scheme (NHG-CSCS/15005).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.