title: Bypassing proximal health care facilities for acute care: a survey of patients in a Ghanaian Accident and Emergency Centre.
abstract: OBJECTIVE
  To characterise the population that presents to the Accident and Emergency Centre (AEC) at Komfo Anokye Teaching Hospital (KATH) and to identify risk factors associated with bypassing proximal care facilities.
  
  
  METHODS
  A structured questionnaire was verbally administered to patients presenting to the AEC over 2 weeks. The questionnaire focused on the use of health care resources and characteristics of current illness or injury. Measures recorded include demographics, socioeconomic status, chief complaint, transportation and mobility, reasons for choosing KATH and health care service utilisation and cost.
  
  
  RESULTS
  The total rate of bypassing proximal care was 33.9%. On multivariate analysis, factors positively associated with bypassing included age older than 38 years (OR: 2.18, P 0.04) and prior visits to facility (OR 2.88, P 0.01). Bypassers were less likely to be insured (OR 0.31, P 0.01), to be seeking care due to injury (OR 0.42, P 0.03) and to have previously sought care for the problem (OR 0.10, P < 0.001).
  
  
  CONCLUSIONS
  Patients who bypass facilities near them to seek care at an urban AEC in Ghana do so for a combination of reasons including familiarity with the facility, chief complaint and insurance status. Understanding bypassing behaviour is important for guiding health care utilisation policy decisions and streamlining cost-effective, appropriate access to care for all patients.
authors.affiliation: Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA. ayaffee@umich.edu
authors.forename: A Q
authors.initials: AQ
authors.lastname: Yaffee
authors.forename: L K
authors.initials: LK
authors.lastname: Whiteside
authors.forename: R A
authors.initials: RA
authors.lastname: Oteng
authors.forename: P M
authors.initials: PM
authors.lastname: Carter
authors.forename: P
authors.initials: P
authors.lastname: Donkor
authors.forename: S D
authors.initials: SD
authors.lastname: Rominski
authors.forename: M E
authors.initials: ME
authors.lastname: Kruk
authors.forename: R M
authors.initials: RM
authors.lastname: Cunningham
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003151:Community Health Centers / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004635:Emergency Medicine / Q000379:methods / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005869:Ghana; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011159:Population Surveillance; D011446:Prospective Studies; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult