Factors Motivating Emergency Department Attendance Among Patients with Non-Urgent Musculoskeletal Disorders: a Case Study in Qatar

Background: The rise in the prevalence of musculoskeletal disorders (MSDs) places a high burden on healthcare services, especially in the emergency departments (EDs) of hospitals in Western and European countries. MSD-related complaints are one of the most common complaints in such EDs where 10-40% of cases are non-urgent and could be treated in a primary health care center (PHCC) instead. Findings on factors driving patients to attend the ED instead of a PHCC are known to vary in different parts of the world ranging from socio-economical factors to cultural preference; however, most studies have been based primarily on western, industrialized countries and findings are not generalizable to rapidly developing countries which exhibit the same phenomenon such as Qatar. This study aims to extend prior research and examine factors driving patients with non-urgent MSDs to attend the ED in the demographically diverse country of Qatar. Study design: Purposive sampling was used to recruit patients with musculoskeletal complaints age 18 years and older in the "See `N Treat" and "Male Fast Track" areas at the ED of Hamad General Hospital (HGH). Patients with non-urgent MSDs were interviewed about main reasons for attending the HGH ED instead of a PHCC. An applied thematic approach was used to analyze data to determine themes and trends among patient responses. Results: 97 patients were interviewed; 70% were men and 30% were women. 70% of patients interviewed were non-Qatari. The median age of all patients was 35.5 years old (IQR, 27-44.2). The main reasons given for attending an ED were: seeking immediate relief from feeling severe pain (63%), perceived severity of the condition as an emergency and believing ED use is appropriate (29%), and referral from other health facilities (9%). The main reasons for attending the ED of HGH particularly were: preference/convenience (49%), access (15%), lack of knowledge (15%), and influence by employer (15%). Conclusion: The majority of patients preferred attending the ED of HGH for the higher quality of services in comparison to other local PHCCs. Low quality MSD management in PHCCs for patients who experience recurrent pain is often a driving factor as well where it was more feasible for them to access services at the ED of HGH instead of a PHCC. A significant portion of non-Qatari patients attended the ED due to lack of knowledge of other services and misadvise from their employers. Such external factors leading to increased burden on the ED of HGH could be addressed by increasing access to alternative centers. Mandating employers to inform employees of the existence of PHCCs and provide them with health services could also reduce the burden of non-urgent ED use. Enforcement of established protocols and strategies on MSD management could also improve the quality of service in PHCCs and contribute to MSD prevention, thus lowering the burden on the healthcare system.