Impact of socioeconomic status on utilisation of a Virtual Emergency Department: An exploratory analysis

Abstract

Objective: To explore whether utilisation of a Virtual Emergency Department (VVED) differs according to socioeconomic status (SES). Methods: A retrospective analysis was undertaken of data from the VVED – a telehealth service that provides care for patients across Victoria, Australia with non-life-threatening emergencies. The study included all individuals who presented to the VVED between July 2022 and June 2023 through the two most common referral pathways (self-referral and ambulance referral). Area-level SES was ascertained by matching residential postcodes to the corresponding Australian Bureau of Statistics (ABS) Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) decile. IRSAD scores were divided into quintiles (1 = lowest SES, 5 = highest SES) and multivariable logistic regression modelling was used to analyse associations between the SES quintile and referral pathway, presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results: There were 68 598 participants included in the analyses (mean age: 36.6 years; 58.4% female). Compared to SES quintile 3, higher odds of self-referral to the VVED were observed in the two most advantaged SES groups (Quintile 4; adjusted OR [aOR] = 1.16; 95% CI: 1.06–1.26; P = 0.001) (Quintile 5; aOR = 1.38; 95% CI: 1.25–1.52; P < 0.001). Conversely, lower odds of self-referral were observed in the most disadvantaged SES group (Quintile 1; aOR = 0.82; 95% CI: 0.75–0.90; P < 0.001). Conclusions: The present study demonstrated a relatively even utilisation of the VVED service across SES population groups. The use of healthcare provider pathways, such as ambulance paramedics, may increase equitable access to telehealth. Clinical attention should be directed toward specific social groups in the emergency care setting.