PDF(Pubmed)
Abstract：
The uncertainties surrounding the COVID-19 pandemic led to a surge in non-urgent emergency department (ED) attendance among people presenting with upper respiratory tract infection (URTI) symptoms. These non-urgent visits, often manageable in primary care, exacerbated ED overcrowding, which could compromise the quality of ED services. Understanding patients\' expectations and the reasons for these ED visits is imperative to mitigate the problem of ED overcrowding. Hence, we assessed the factors influencing patients\' expectations for diagnostic tests during their ED visits for uncomplicated URTI during different phases of the pandemic.
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.
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.
摘要：
■围绕COVID-19大流行的不确定性导致出现上呼吸道感染（URTI）症状的非紧急急诊科（ED）就诊人数激增。这些非紧急访问，在初级保健中通常是可控的，加剧了ED的过度拥挤，这可能会损害ED服务的质量。了解患者的期望和这些ED就诊的原因对于缓解ED过度拥挤的问题至关重要。因此，我们评估了影响患者在大流行不同阶段对无并发症URTI进行ED访视期间对诊断性检查期望的因素.
■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。
■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。
