• Ann Emerg Med · Sep 2020

    Emergency Department Utilization for Patients Living With Sickle Cell Disease: Psychosocial Predictors of Health Care Behaviors.

    • Khadijah Abdallah, Ashley Buscetta, Kayla Cooper, Julia Byeon, Andrew Crouch, Sabrina Pink, Caterina Minniti, and Vence L Bonham.
    • Social and Behavioral Branch, National Human Genome Research Institute, National Institute of Health, Bethesda, MD. Electronic address: khadijah.abdallah@nih.gov.
    • Ann Emerg Med. 2020 Sep 1; 76 (3S): S56-S63.

    Study ObjectiveIndividuals living with sickle cell disease (SCD) often require urgent care; however, some patients hesitate to present to the emergency department (ED), which may increase the risk of serious clinical complications. Our study aims to examine psychosocial, clinical, and demographic factors associated with delaying ED care.MethodsThis was a cross-sectional study of 267 adults with SCD from the national INSIGHTS Study. The binary outcome variable asked whether, in the past 12 months, participants had delayed going to an ED when they thought they needed care. Logistic regression was performed with clinical, demographic, and psychosocial measures.ResultsApproximately 67% of the participants reported delaying ED care. Individuals who delayed care were more likely to have reported higher stigma experiences (odds ratio [OR]=1.09; 95% confidence interval [CI] 1.03 to 1.16), more frequent pain episodes (OR=1.15; 95% CI 1.01 to 1.32), lower health care satisfaction (OR= 0.74; 95% CI 0.59 to 0.94), and more frequent ED visits (OR=6.07; 95% CI 1.18 to 31.19). Disease severity and demographics, including sex, age, and health insurance status, were not significantly associated with delay in care.ConclusionPsychosocial factors, including disease stigma and previous negative health care experiences, are associated with delay of ED care in this SCD cohort. There is a need to further investigate the influence of psychosocial factors on the health care-seeking behaviors of SCD patients, as well as the downstream consequences of these behaviors on morbidity and mortality. The resulting knowledge can contribute to efforts to improve health care experiences and patient-provider relationships in the SCD community.Copyright © 2020 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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