We conducted a cross-sectional study on adults with URTI symptoms seeking care at four public EDs in Singapore between March 2021 and March 2022. We segmented the study period into three COVID-19 pandemic phases-containment, transition, and mitigation. The outcome variables are whether patients expected (1) a COVID-19-specific diagnostic test, (2) a non-COVID-19-specific diagnostic test, (3) both COVID-19-specific and non-COVID-19-specific diagnostic tests, or (4) no diagnostic test. We built a multinomial regression model with backward stepwise selection and classified the findings according to Andersen\'s healthcare utilization model.
The mean age of participants was 34.5 (12.7) years. Factors (adjusted odds ratio [95% confidence interval]) influencing expectations for a COVID-19-specific diagnostic test in the ED include younger age {21-40 years: (2.98 [1.04-8.55])}, no prior clinical consultation (2.10 [1.13-3.89]), adherence to employer\'s health policy (3.70 [1.79-7.67]), perceived non-severity of illness (2.50 [1.39-4.55]), being worried about contracting COVID-19 (2.29 [1.11-4.69]), and during the transition phase of the pandemic (2.29 [1.15-4.56]). Being non-employed influenced the expectation for non-COVID-19-specific diagnostic tests (3.83 [1.26-11.66]). Factors influencing expectations for both COVID-19-specific and non-COVID-19-specific tests include younger age {21-40 years: (3.61 [1.26-10.38]); 41-60 years: (4.49 [1.43-14.13])}, adherence to employer\'s health policy (2.94 [1.41-6.14]), being worried about contracting COVID-19 (2.95 [1.45- 5.99]), and during the transition (2.03 [1.02-4.06]) and mitigation (2.02 [1.03-3.97]) phases of the pandemic.
Patients\' expectations for diagnostic tests during ED visits for uncomplicated URTI were dynamic across the COVID-19 pandemic phases. Expectations for COVID-19-specific diagnostic tests for ED visits for uncomplicated URTI were higher among younger individuals and those worried about contracting COVID-19 during the COVID-19 pandemic. Future studies are required to enhance public communications on the availability of diagnostic services in primary care and public education on self-management of emerging infectious diseases such as COVID-19.
■我们对2021年3月至2022年3月期间在新加坡的四个公共ED上寻求治疗的患有URTI症状的成年人进行了横断面研究。我们将研究期间分为三个COVID-19大流行阶段-遏制,过渡,和缓解。结果变量是患者是否期望(1)COVID-19特异性诊断测试,(2)非COVID-19特异性诊断测试,(3)COVID-19特异性和非COVID-19特异性诊断测试,或(4)没有诊断测试。我们建立了一个向后逐步选择的多项回归模型,并根据Andersen的医疗保健利用模型对研究结果进行了分类。
■参与者的平均年龄为34.5(12.7)岁。影响ED中COVID-19特异性诊断测试预期的因素(调整后比值比[95%置信区间])包括年龄较小{21-40岁:(2.98[1.04-8.55])},没有事先的临床咨询(2.10[1.13-3.89]),遵守雇主的卫生政策(3.70[1.79-7.67]),感知的非疾病严重程度(2.50[1.39-4.55]),担心感染COVID-19(2.29[1.11-4.69]),在大流行的过渡阶段(2.29[1.15-4.56])。未就业影响了对非COVID-19特异性诊断测试的期望(3.83[1.26-11.66])。影响COVID-19特异性和非COVID-19特异性测试预期的因素包括年龄{21-40岁:(3.61[1.26-10.38]);41-60岁:(4.49[1.43-14.13])},遵守雇主的卫生政策(2.94[1.41-6.14]),担心感染COVID-19(2.95[1.45-5.99]),以及在大流行的过渡(2.03[1.02-4.06])和缓解(2.02[1.03-3.97])阶段。
■在COVID-19大流行阶段,患者在急诊就诊期间对诊断测试的期望是动态的。在年轻人和担心在COVID-19大流行期间感染COVID-19的人中,对COVID-19特异性诊断测试对不复杂的URTI的ED访问的期望更高。未来的研究需要加强关于初级保健诊断服务可用性的公共沟通,以及关于新冠肺炎等新发传染病自我管理的公共教育。