A multilevel analysis of demographic and contextual factors associated with emergency department visits and access block in Queensland

Résumé fourni par la source

Studies on factors associated with emergency department (ED) use, including demographic and contextual factors such as the remoteness of the area of residence and the availability of home support programs, are scarce but may better explain ED demand than studies based only on demographic factors. Furthermore, most studies are based on the nonplausible assumption that there is no geographical variation in factors associated with ED use across states or territories. This study aimed to assess whether contextual factors related to context or the environment, in addition to demographic factors, can improve our understanding of ED use in Queensland, Australia. Spatial analyses were performed to understand the factors more likely to drive ED demand and access block (AB) in different areas of the state. Data on all ED visits in Queensland in 2021 were aggregated by 1-year age groups for each postcode of patients’ residential area and matched to the corresponding denominator population as well as to demographic and contextual factors. When assessing factors associated with ED demand and AB, including contextual factors improved model fit compared with models comprising demographic factors only. The associations between ED visits and age appeared nonlinear. The highest rates of ED visits were observed among residents aged > 75 years, followed by those aged < 5 years and those aged 20–35 years. Across the state, a 1-year increase in patient age was associated with a 2% increase in the rates of AB. Queenslanders with low education levels are more likely to experience ED visits and AB. Residents living outside of metropolitan areas were less likely to access the ED but were more likely to experience AB when they attended the ED. Interestingly, increased numbers of Prolonged Level D GP visits (40 + minutes) and aged care places were associated with decreased rates of ED visits. Prolonged Level D GP visits were substantially more likely to be associated with reduced ED visits outside of the capital city and its neighbouring areas. Prolonged GP visits (especially in remote areas), multidisciplinary case conferences and other forms of integrated care should be considered in policies aimed at reducing ED demand. Not applicable.