Awareness and Utilisation of Primary Healthcare to Reduce Emergency Department Overcrowding in Saudi Arabia

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Abstract

Background

Patients seeking emergency department (ED) care for non-acute conditions are a major contributor to ED overcrowding, which results in longer wait times.

Method

This was a cross-sectional study, conducted using an online survey among the Saudi population to assess their awareness about primary healthcare clinics (PHCCs) and urgent care clinics (UCCs), their role, and their scope of practice.

Results

A total of 565 participants were included in this study. Most of the respondents (81.1%) reported lengthy waiting times in the ED. Moreover, most (81.6%) stated that they had never visited a family doctor, yet they (92.6%) favoured having one for follow-up care. Close to half of the participants (50.3%) reported attending PHCCs without an appointment, and the majority of them (69.2%) said that PHCCs were overcrowded. Finally, most participants (92.4%) had not heard aboutUCCs.

Conclusion

ED overcrowding and prolonged waiting times remain a public concern. PHCCs and UCCs are underutilised, and this is attributed to the lack of awareness about their scope and their services.

Keywords: Awareness, Emergency department, Primary healthcare center, Overcrowding

Introduction

The term “emergency department (ED) overcrowding” refers to a situation in which the demand for emergency services exceeds the capacity of nurses and physicians to deliver appropriate care promptly [1]. Globally, patients seeking care for non-acute conditions lead to ED overcrowding, resulting in longer wait times for medical intervention regardless of severity [2]. This may lead to patient dissatisfaction and a higher risk of death, and contribute to higher health system costs [3, 4]. ED crowding has been identified as a problem that occurs in most developed countries, and is described as a worldwide public health problem [5]. Some of the increased demand is related to patients with primary care problems who use emergency department settings to access care [6], although a large proportion of those patients (10%–60%) can be managed using lower-acuity care services [7]. A recent review of various studies identified the main reasons for ED and urgent care clinic (UCC) attendance, which included a lack of access to primary care; perceptions of urgency or anxiety; recommendations from friends, family, or healthcare professionals; and convenience in terms of better opening hours or being closer to home than alternatives [8]. One solution to the problem is to improve guidance and enhance access to primary care services. Primary care physicians are not limited to a specific disease; they are trained to manage any kind of illness through a holistic, patient-centred approach and in connection with every other medical speciality [9].

In Saudi Arabia, a study conducted at an urgent care clinic found that most participants were unaware of urgent care and the service that can be delivered [5]. Meanwhile, studies showed a positive impact of PHCC on ED length of stay, patient satisfaction, patient safety, and departure before completion of service [10]. Also in Saudi Arabia, studies showed a significant association between overcrowding and length of stay [11]. The main objective of our study is to investigate the potential of PHCC and urgent care to improve ED crowding and to explore the importance of PHCCs as an alternative to treat mild cases that do not constitute a emergency. We also aim to explore the awareness of the general population of the role of PHCCs and UCCs.

Methodology

We estimated a sample size of the total population of Saudi Arabia (34 000 000) to be 385 participants, using the Raosoft calculator, with a 5% level of significance, 5% margin of error, 95% confidence and expected response distribution of 50%. We used the chi-square (X 2) statistic and Fisher’s exact test where appropriate. Data analysis was conducted using SPSS version 25.

Perception toward the primary healthcare scope of practice:

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