Evaluation of the factors associated with inappropriate use of the emergency department and the role of primary care at King Fahd Hospital, Jeddah City

  • Sundus Dawoud

Student thesis: Phd


In Saudi Arabia, over 60% of healthcare services, including primary, secondary and tertiary services, are provided by the Ministry of Health. All citizens in Saudi Arabia can avail of free and unlimited health care, but there are several challenges to accessibility. One major challenge is that many patients directly visit the emergency department (ED) of hospitals, even in cases where their issues can be treated at primary healthcare centres (PHCCs). This impacts healthcare efficiency, as available PHCC services are underused and expensive ED services are overused. This research aims to understand why patients who could be treated at PHCCs seek care at EDs in Saudi Arabia. The planned study specifically examines whether there are differences in the characteristics, knowledge, behaviour and satisfaction of patients presenting at PHCCs compared to patients who present at EDs but could be treated at PHCCs. The main goal of this research is to identify factors that could be used by commissioners and policy makers in Saudi Arabia to improve the usage of PHCCs and reduce the inappropriate use of EDs. Methods: A cross-sectional survey was conducted at King Fahd Hospital and three of its associated PHCCs in Jeddah city. This study included adult patients who consulted PHCCs and adult patients who presented at the ED of the hospital with non-urgent health problems (which are treatable at PHCCs). All participants were interviewed using structured questionnaires specifically devised for the purposes of this study. A participant information sheet explaining the purpose of this study was given to all potential participants, and informed consent was sought at the start of the study. Anonymised data were analysed using the SSPS software. Descriptive statistics used to define the characteristics of the study variables by using counts and percentages for the categorical and nominal variables and means and standard deviations for continuous variables. Reliability and validity tests were considered, I used a model of alpha (Cronbach) and communalities (factor analysis). The chi-square test was used to determine differences in categorical variables, t-test to calculate means and standard deviations for continuous variables, and Welch’s t-test was used as an alternative test for data with non-normal distribution. To correlate the domains represented by means and standard deviation, the Pearson’s correlation coefficient was used. The significant factors have been identified by a binary logistic regression model with 95% confidence intervals and a conventional p-value of
Date of Award31 Dec 2022
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorAneez Esmail (Supervisor) & Maria Panagioti (Supervisor)


  • Emergency Department
  • Healthcare services
  • Primary care Access
  • Healthcare Access
  • Emergency crowding
  • Emergency Services
  • Inappropriate Use

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