Factors Influencing Willingness To Utilize the Emergency Department Among Individuals Living With Sickle Cell Disease

Speaker(s)

Ibiloye E1, Odonkor G2, Barner J3, Brown CM3, Kang HA3, Bamgbade BA4
1Alexion, Astrazeneca Rare Disease, Boston, MA, USA, 2The University of Texas at Austin, Austin , TX, USA, 3The University of Texas at Austin, Austin, TX, USA, 4Northeastern University, Boston, MA, USA

Presentation Documents

OBJECTIVES: Sickle cell disease (SCD) is characterized by unexpected pain crises, known as vaso-occlusive crises, which often necessitate emergency department (ED) use. However, patients with SCD often delay seeking ED care. Using the Theory of Planned Behavior (TPB), this study aimed to determine the factors that influence SCD patients’ willingness to use the ED when in pain.

METHODS: SCD patients aged ≥18 years who had a previous ED visit were included. A web-based survey was developed using TPB direct (attitude, subjective norms and perceived behavioral control) and indirect (salient beliefs elicited from prior focus group sessions) measures, and two additional constructs, prior patient experience and stigma, which were derived from validated scales. Covariates included demographic and personal characteristics. Linear regression analyses was used to address the study aim.

RESULTS: Out of 259 respondents, only 114 were eligible for inclusion. The overall TPB model was significant and explained 61% of the variance in willingness to use the ED while in pain (adjusted R2=0.6102, p<0.0001). Direct attitude (b=0.50, p<0.0001) and frequency of ED use (b=0.57, p=0.0005) were the only significant predictors. Prior patient experience and stigma did not significantly improve the predictive power of the TPB model, as many of their items were similar to those in the attitude scale. Regarding the indirect attitude measure, being mistreated by ED providers and categorized as a drug seeker, experiencing long wait times, being strategic to get care, having to advocate for pain control, and not having your voice heard, emerged as salient beliefs.

CONCLUSIONS: This findings of this study support the utility of the TPB in predicting willingness to use the ED among individuals with SCD. Interventions that focus on promoting more favorable attitudes may be beneficial in developing strategies to improve SCD patient experience in the ED and their willingness to use the ED when in pain.

Code

HSD38

Topic

Health Policy & Regulatory, Patient-Centered Research

Topic Subcategory

Health Disparities & Equity, Patient Behavior and Incentives

Disease

Rare & Orphan Diseases