Inflammatory Arthritis Patient Decision Making to Attend, and Experience of, Emergency Department Use.

OBJECTIVE:Patients may use emergency departments (ED) to meet their health needs whenambulatory care systems are not sufficient. We aim to describe contributing factors to the decision taken by persons with inflammatory arthritis (IA) to present to the ED, and their experiences of ED care and post-discharge follow-up. METHODS:An embedded mixed methods approach was taken to contextualize quantitative data with associated free text responses from an online survey distributed to residents of Alberta with a known IA condition and an ED visit. RESULTS:82 persons with RA (48%), PsA (12%), SpA (6%), and Gout (34%) (63% 16-55 years, 48% female, 50% urban residents) completed the survey. Presenting concerns were arthritis flare (37%), chest pain (15%), injury (12%) and infection (11%). Of all visits, 29% of persons proceeded directly to the ED, 35% attempted accessing ambulatory care first and 32% were a return visit. In presentations for arthritis flare, patients were aware of the rheumatology service being contacted by the ED provider for advice in just 9% of events. Only 26% of patients were asked to follow up with a rheumatologist of which 38% were unable to do so in the time frame suggested. Challenges in healthcare system coordination and system pressures resulted in patients requiring ED attendance to assess their concern. The quality of communication and relationality developed between IA patients and healthcare providers informed experiences of ED care. CONCLUSION:Modifying rheumatology ambulatory care models could better meet patient needs and ultimately reduce avoidable ED use by IA patients.