Factors contributing to appropriateness of utilisation among adult patients attending Emergency Department Hospital Kuala Kubu Bharu 2017

Introduction: Emergency and non- emergency utilisation at hospital emergency department is a common occurrence around the world as well in Malaysia. In Selangor, there had been a general increase in the numbers of patients seeking treatment at the emergency department. Such utilisation if inappropriate give rise to overcrowding, long waiting times and unnecessary usage of healthcare resources. Objectives: To determine the level of appropriateness of utilisation by patients attending to Hospital Kuala Kubu Bharu emergency department and the factors contributing to it. Methods: A cross sectional study utilising systematic random sampling were carried out at the emergency department of Hospital Kuala Kubu Bharu. Self-administered questionnaire was given to respondents at the emergency department. Descriptive and analytical statistics were derived from IBM Statistical Package for Social Science(SPSS) version 22.0, with a pre-determined p<0.05 as significant value. Chi square and binomial logistic regression were used to determine the predictors of appropriateness of utilisation. Results: The total number of respondents in this study were 771 (88.2%). The median age of respondents were 33 years of age (IQR ± 25th, 75th; 25, 42). Majority of the respondents were of Malay ethnicity (64.9%). The percentage of respondents comprised of female (55.9%) and male (44.1%) respectively. The results of chi-square test indicated that there were significant association between time of presentation (p= 0.005), 24-hours availability of the emergency department to respondents (p=0.014) and employment status (p=0.024). Using binomial logistic regression, the results further revealed that the odds of appropriateness in respondents to utilise the emergency department after office hours is 1.5 times more in comparison to after office hours (AOR=1.520, 95% CI: 1.126-2.052). Respondents are also more likely to utilise the emergency department due to its 24-hour availability compared to other facilities (AOR =2.851 95% CI: 1.276-6.375). Conclusion: The level of appropriateness of utilisation at Emergency Department of Hospital Kuala Kubu Bharu is 72.2% appropriate. From the multivariate analysis it reveals that, time of presentation and 24-hours availability of the emergency department were significantly associated with appropriateness of utilisation.

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