Care-seeking behavior of COVID-19 cases during the first eight weeks of the outbreak in Singapore: differences between local community and imported cases and having visits to one or more healthcare providers | BMC Public Health

Our study revealed differences in care-seeking behavior among subgroups of early COVID-19 cases in Singapore. Locally acquired cases had a significantly longer time from symptom onset to hospital admission than imported cases (median 6 days versus 4 days). Among those who had at least one pre-admission visit, a higher percentage of locally acquired cases had seen a doctor at the primary care level than imported cases (89.8% versus 56.5%).

Imported cases were more likely to go to the ED, bypassing primary care clinics altogether (43.5% of imported cases versus 10.2% of locally acquired cases went directly to the ED without any clinic visit, p

In contrast, doctors’ perception of a lower risk of community transmission at the time led to locally acquired cases being referred only after there was no clinical improvement despite repeat visits. Equally crucial is the patient’s personal knowledge and health literacy. [15,16,17]. Locally acquired cases may have attributed their symptoms to a cold or gastroenteritis, leading to delays of up to a month in seeing a doctor. Although seemingly harmless under normal circumstances, it could have devastating consequences in the event of an outbreak.

Overall, Singapore residents were more likely to attend primary care clinics than non-residents (84.0% versus 58.7%). Fever, cough, sore throat and diarrhea were common symptoms of COVID-19 cases [18], routinely managed in the community by family physicians.

Among the subgroup of locally acquired cases with at least two primary care visits who saw the same care provider (median of 2 visits), a smaller proportion (27.6%) had three or more visits before diagnosis. being referred and admitted, compared to 61.4% of those who consulted different providers (median of 3 visits). Having no basis for comparison with previous visits, another health care provider lacks relevant information when formulating the patient’s management plan, which usually leads to diagnosis, isolation and treatment later, and therefore increases the risk of transmission. Our results thus highlight the risk of being treated by several healthcare providers or of “doctor shopping” within the same episode of illness. [19,20,21].

Physician purchases could be attributed to various factors. One of the factors is accessibility to health care; with high concentrations of primary care clinics throughout the island, the convenience of traveling to clinics close to one’s place of work and home outweighs concerns about continuity of care [19, 22,23,24]. Another factor is unmet expectations; patients may have misconceptions about taking less effective medications when symptoms persist or feel dissatisfied with previous consultations [19, 22,23,24]. Therefore, appropriate public health communication to the public is crucial even in times of peace.

We recognized several limitations to our study. The observational design of our study excluded causal inference. This study was limited to the initial period of COVID-19 where cases were mainly imported. As the epidemic progressed, care-seeking behaviors would change, and as such, a thorough study would be useful to determine the attitudes and responses of the people of Singapore to each phase of the epidemic. Our study was limited to cases diagnosed and managed in Singapore, and the findings cannot be generalized to the care-seeking behavior of COVID-19 cases in other countries with health systems and coping mechanisms. different funding. Because some information about primary care visits before hospitalization was verified based on self-reports, the data collected was subject to recall bias. Nonetheless, standard operating procedures were in place to ensure the accuracy and consistency of documented information, such as training public health workers to interview cases and verifying reported case movements from other sources.

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