Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Wilk, Piotr

Abstract

Emergency department (ED) visits for primary healthcare-treatable conditions are preventable and indicate barriers to primary healthcare. The goal of this thesis was to explore the prevalence and key correlates of preventable ED visits among adults in Canada. Our systematic review found that the prevalence of these visits ranged from 4.3% to 59.1% and were associated with younger age, low education, low income, rural residence, and worse self-rated health. Our analysis of data from the 2015-2016 Canadian Community Health Survey found that 39.9% of adults with a regular healthcare provider considered their last ED visit to be preventable. In addition to age, education, and income, these visits were associated with being female, being employed, non-white ethnicity, having no recent consultations with a medical doctor, a strong sense of community belonging, and worse self-rated mental health. Future research should explore the healthcare experiences of these sub-populations to improve their access to care.

Summary for Lay Audience

Countries around the world have experienced a rapid increase in emergency department (ED) visits over the past decade, which contributes to healthcare problems such as hospital overcrowding and increased wait times. While EDs are meant to provide emergency care to those with life-threatening injuries and illnesses, an increasingly large proportion of ED visits are being made for reasons or conditions that could be treated or appropriately managed in primary care settings. These visits are considered to be preventable, as patients should be able to receive care from a primary healthcare provider (HCP) rather than visit the ED for a health problem that could have been otherwise treated or managed at the level of primary healthcare. It is important to identify the patient characteristics and factors associated with these visits so that healthcare policies can be developed to better address patients’ healthcare needs. Therefore, the goal of this thesis was to estimate the proportion of ED visits in Canada that are preventable and to identify factors that may increase patients’ likelihood of having a preventable ED visit.

We summarized the findings from previous Canadian studies and found that 4.3% to 59.1% of ED visits were reported to be preventable. Patients who were of younger age, low education, low income, lived in rural areas, and had worse self-rated health were more likely to have a preventable ED visit. We also analyzed data from the 2015-2016 Canadian Community Health Survey and found that 39.9% of adults with a regular HCP considered their last ED visit to be preventable. In addition to age, income, and education, patients who were female, employed, of non-white ethnicity, had no recent consultations with a medical doctor, had a strong sense of community belonging, and had worse self-rated mental health were more likely to have a preventable ED visit. In conclusion, a considerable proportion of ED visits in Canada are preventable, and patients with certain characteristics are more likely to have a preventable ED visit. Future research that explores the healthcare experiences of these patients would assist healthcare policymakers in better understanding their difficulties in accessing primary healthcare.

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Creative Commons Attribution-Noncommercial 4.0 License
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Available for download on Saturday, November 13, 2021

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