Impact of COVID-19 on emergency department attendance in an Australia hospital: a parallel convergent mixed methods study.

OBJECTIVES: The COVID-19 pandemic has changed the way people are accessing healthcare. The aim of this study was to examine the impact of COVID-19 on emergency department (ED) attendance for frequent attenders and to explore potential reasons for changes in attendance. DESIGN: This convergent parallel mixed methods study comprised two parts. SETTING: 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. PARTICIPANTS: A total of 4868 patients were included in the time series. A subgroup of 200 patients were interviewed, mean age 66 years (range 23-99). RESULTS: 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 67% across emergency triage categories. 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. CONCLUSIONS: This study demonstrated reduced ED 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.

Impact of the COVID-19 Pandemic on Resilience to Climate Change in Underserved Communities

Coastal communities in South Louisiana and worldwide are increasingly impacted by climate-related events such as hurricanes, floods, and rising sea levels. In addition, they have recently faced the burden of a global pandemic that may also be a consequence of climate change. In many under-resourced communities, nongovernmental community-based organizations (CBOs) represent the backbone of the response to the COVID-19 pandemic. However, little is known about the pandemic's impact on the efforts of these organizations to support and sustain individual and community resilience to this event and to the disruptive impacts of climate change-related weather events. Procedures embedded in the Rapid Assessment Procedure - Informed Community Ethnography methodology were used to analyze data collected from semi-structured interviews with 26 representatives of 24 different community-based programs in South Louisiana. The pandemic created numerous challenges to under-resourced community resilience by revealing the fragmented nature of community solidarity in adhering to public health guidelines;the lack of available social, political, and economic resources;and the influence of systemic racism and social determinants of health. To address these challenges, communities relied on social connections and support;prior experiences with climate-related disasters and adversity;and the resilience building, supporting, and sustaining efforts of CBOs. These organizations have responded to these challenges through provision of new services, expansion of existing services, providing access to training webinars, partnerships with other CBOs, and initiatives to address broader social issues, while balancing the disparity between increased demand and reduced supply of services and increased reliance on technology that is not uniformly accessible to all communities and residents. In responding to the pandemic, CBOs have played a major role in addressing the threats to individual and community resilience needed to prepare for and respond to natural disasters and other consequences of global environmental change in underserved communities. © Copyright 2021, Mary Ann Liebert, Inc., publishers 2021.