The Impact of COVID-19 on Emergency Department Attendance in a Vulnerable Population - The What, and the Why

Background: The COVID-19 pandemic has changed the way people are accessing healthcare. The aim of this study was to examine the impact of coronavirus (COVID-19) on emergency department (ED) attendance for frequent attenders and to explore potential reasons for changes in attendance. Methods: This convergent parallel mixed methods study comprised two parts. An interrupted time-series analysis evaluated changes in ED presentation rates; interviews investigated reasons for changes for frequent ED users in a culturally and linguistically diverse setting. Findings: Interrupted time series analysis from 4868 eligible participants showed an instantaneous decrease in weekly ED presentations by 36% (p<0.001), with reduction between 45% and 66% across emergency triage categories. 200 patients were interviewed, mean age 66 years (range 23-99). 32% did not know they could leave home to seek care with differences seen in English versus non-English speakers (p<0.001). 35% reported postponing medical care. There was a high fear about the health system becoming overloaded (mean 4.2 (±2) on 6-point scale). Four key themes emerged influencing health seeking behaviour: Fear and/or avoidance of hospital care; Use of telehealth for remote assessment; No fear or avoidance of hospital care; Not leaving the house for any reason. Interpretation: This study demonstrated reduced emergency department use by a vulnerable population of previously frequent attenders. COVID-19 has resulted in some fear and avoidance of hospitals, but has also offered new opportunity for alternative care through telehealth. Funding: Northern Health Foundation; Inner North West, Health West and Hume Whittlesea Primary Care Partnerships; La Trobe University. Declaration of Interests: All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three year, no other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: This project was reviewed by an ethics committee that included consumer representatives that were able to provide feedback on methods (including interview questions). All participants were patients of Northern Health.