Access, Use, and Patient-Reported Experiences of Emergency Care During the COVID-19 Pandemic: Population-Based Survey

Abstract

Background: An increase in the number of people presenting to emergency departments (EDs) is contributing to ED overcrowding. In the early stages of the COVID-19 pandemic, there was a significant reduction in the number of ED presentations in Australia, creating an opportunity to learn from patients' experiences of alternative management options.

Objective: The aim of this study is to report on the use and experience of health services by Australian adults experiencing a health issue during the COVID-19 pandemic for which they would have presented at an ED prior to the pandemic.

Methods: An online survey was conducted in May 2020. Reported health issues were categorized using an existing classification system. Data collected included demographics, care pathways, levels of concern at times of health issue and survey completion, and patient-reported experiences with care.

Results: A total of 1289 eligible respondents completed the survey. Almost 25% (309/1289) of respondents avoided an ED presentation, of which 58% (179/309) used an alternative form of health care and 42% (130/309) self-managed. Respondents making face-to-face or telehealth appointments with their general practitioner (GP) reported high levels of ED avoidance (135/286, 47%) and mostly positive experiences of care provided by GPs. A high proportion of those who self-managed reported high levels of concern at the time of completing the survey (42/130, 32%).

Conclusions: Telehealth consultations with GPs may be a more promotable alternative to the ED beyond the COVID-19 pandemic, providing easier access to a doctor with access to patients' medical histories than an appointment for a face-to-face consultation. GP telehealth consultations may also address barriers to accessing health care for those with potentially the greatest need. The reported use and positive experiences with GP telehealth appointments should inform further research on their appropriateness as an alternative to the ED.

Keywords: COVID-19; ED avoidance; access; barrier; emergency department; emergency department avoidance; experience; patient-reported; survey; telehealth; telemedicine; usage.

Figure 1

Respondent characteristics. Characteristics of all respondents included in the analysis and for respondents by care choice. Panels show data by (A) care choice, (B) age, (C) gender, (D) state, (E) region, (F) self-rated overall health, (G) health event of concern, and (H) concern at time of event. ACT: Australian Capital Territory; CV: cardiovascular; ED: emergency department; GI: gastrointestinal; MH: mental health; MSK: musculoskeletal; NSW: New South Wales; NT: Northern Territory; Qld.: Queensland; SA: South Australia; Tas.: Tasmania; Vic.: Victoria; WA: Western Australia.

Figure 2

Respondents' levels of concern and care choices. Sankey figure mapping respondents' level of concern at the time of the health event (green bars), their care choices (blue and red bars), and level of concern at the time of completing the survey (orange bars). An interactive version of this figure is available in Multimedia Appendix 5. ED: emergency department; GP: general practitioner.

Figure 3

Patient experiences with care for those who only contacted another provider (GP face-to-face and GP telehealth appointments). The 10-item Generic Short Patient Experiences Questionnaire uses Likert scales to assess patient experiences with the non-ED care received. Negative experience (dissatisfied) includes the two most negative responses. Positive experience (satisfied) includes the two most positive responses. The wait time question used a 4-point Likert scale, while all other questions used a 5-point Likert scale. ED: emergency department; GP: general practitioner.