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Factors Associated with Reluctance to Use an Emergency Department in a Multi-ethnic Community

Results of a Telephone Survey

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Canadian Journal of Public Health Aims and scope Submit manuscript

Abstract

Background

Delays in seeking emergency care when experiencing serious symptoms may increase morbidity and mortality. Understanding the reasons for such delays may result in interventions to reduce them. We examined the relationship between ethnicity and the reluctance to use an emergency department (ED).

Methods

An exploratory multilingual telephone survey was completed in Greater Vancouver, British Columbia, with randomly selected men and women, aged 40 years and older, listed in the BC Ministry of Health Services Client Registry Database. Survey items included whether the respondents were “somewhat,” “very” or “not” reluctant to use an ED. Reasons for reported degree of reluctance and potential correlates were explored including age, gender, income, education, anxiety, vulnerability, self-reported health status, life stress, and satisfaction with a previous ED visit. Multiple logistic regression analysis was conducted.

Results

Among 973 (56% response rate) participants (56.3% female) were 149 Chinese, 67 South Asian, 221 foreign-born (not Chinese or South Asian), and 536 Canadian-born participants (not Chinese or South Asian). Controlled for all potential confounders, Chinese (OR=0.30, 95% CI=0.19, 0.48) respondents were less likely than Canadian-born participants to report reluctance to use an ED. Anxiety (OR=1.05, 95% CI=1.02, 1.09) and dissatisfaction with a previous ED visit (OR=1.85, 95% CI=1.27, 2.68) were significant correlates.

Conclusions

Canadian-born participants may be at higher risk of delaying necessary treatment from EDs that have been publicized to have long waiting times. Further studies are needed to understand the role ethnicity plays in ED utilization.

Résumé

Contexte

Le fait de tarder à se rendre à l’urgence lorsqu’on éprouve des symptômes graves peut accroître la morbidité et la mortalité. En connaissant les raisons de tels retards, il serait peut-être possible d’agir pour les réduire. Nous avons examiné la relation entre l’appartenance ethnique et la réticence à faire appel à un service d’urgence.

Méthode

Nous avons mené une enquête téléphonique préliminaire multilingue dans le Grand Vancouver (Colombie-Britannique) auprès d’hommes et de femmes de 40 ans et plus, sélectionnés au hasard, dont les noms figuraient dans le registre des usagers du ministère des Services de santé de la Colombie-Britannique. Nous avons demandé aux répondants s’ils étaient « un peu », « très » ou « pas du tout » réticents à faire appel à un service d’urgence. Nous avons analysé les raisons citées pour expliquer le niveau de réticence et les corrélats éventuels (l’âge, le sexe, le revenu, l’instruction, l’anxiété, la vulnérabilité, l’état de santé déclaré par l’intéressé, le stress dans la vie personnelle et la satisfaction par rapport à une visite antérieure à l’urgence). Nous avons ensuite procédé à une analyse de régression logistique multiple.

Résultats

Sur les 973 participants (taux de réponse = 56 %; proportion des femmes = 56,3 %), 149 étaient Chinois, 67 étaient Asiatiques du Sud, 221 étaient nés à l’étranger (sans être Chinois ni Asiatiques du Sud), et 536 étaient nés au Canada (sans être originaires de Chine ni d’Asie du Sud). Compte tenu de tous les facteurs confusionnels possibles, les répondants chinois (RC=0,30, IC de 95 % =0,19-0,48) étaient moins susceptibles que les répondants nés au Canada d’éprouver de la réticence à utiliser un service d’urgence. L’anxiété (RC=1,05, IC de 95 %=1,02-1,09) et l’insatisfaction par rapport à une visite antérieure à l’urgence (RC=1,85, IC de 95 %=1,27-2,68) étaient des corrélats significatifs.

Conclusion

Les personnes nées au Canada pourraient courir un risque plus élevé de tarder à se faire soigner dans les urgences qui passent pour avoir de longs délais d’attente. Il faudrait mener d’autres études pour approfondir le rôle de l’appartenance ethnique dans l’utilisation des services d’urgence.

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Author information

Authors and Affiliations

  1. NEXUS, University of British Columbia, 302-6190 Agronomy Road, Vancouver, BC, V6T 1Z3, Canada

    Birgit Reime ScD, MPH & Pamela A. Ratner PhD, NR

  2. Nursing & Health Behaviour Research Unit, School of Nursing, University of British Columbia, Vancouver, Canada

    Andrew W. Tu MSc, Roula Tzianetas MSc & Pamela A. Ratner PhD, NR

Authors
  1. Birgit Reime ScD, MPH
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  2. Andrew W. Tu MSc
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  3. Roula Tzianetas MSc
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  4. Pamela A. Ratner PhD, NR
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Corresponding author

Correspondence to Birgit Reime ScD, MPH.

Additional information

Sources of funding: This work was supported in part by a Canadian Institutes of Health Research operating grant, a Michael Smith Foundation for Health Research (MSFHR) research unit infrastructure award, and MSFHR Senior Scholar award to the last author.

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Reime, B., Tu, A.W., Tzianetas, R. et al. Factors Associated with Reluctance to Use an Emergency Department in a Multi-ethnic Community. Can J Public Health 98, 222–227 (2007). https://doi.org/10.1007/BF03403717

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  • DOI: https://doi.org/10.1007/BF03403717

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