title: Subjective reasons why immigrant patients attend the emergency department.
abstract: BACKGROUND
  Some patients visit a hospital's emergency department (ED) for reasons other than an urgent medical condition. There is evidence that this practice may differ among patients from different backgrounds. The objective of this study was to examine the reasons why patients from a non-English speaking background (NESB) and patients with an English speaking background but not born in Australia (ESB-NBA) visit the ED, as compared to patients from English-speaking backgrounds but born in Australia (ESB-BA).
  
  
  METHODS
  A cross-sectional survey was conducted at the ED of a tertiary hospital in metropolitan Brisbane, Queensland, Australia. Over a four-month period patients who were assigned an Australasian Triage Scale score of 3, 4 or 5 were surveyed. Pearson chi-square test and multivariate logistic regression analyses were performed to examine the differences between the ESB and NESB patients' reported reasons for attending the ED.
  
  
  RESULTS
  A total of 828 patients participated in this study. Compared to ESB-BA patients NESB patients were less likely to consider contacting a general practitioner (GP) before attending the ED (Odds Ratios (OR) 0.6 (95% Confidence Interval (CI) 0.4-0.8, p < .05) While ESB-NBA were more likely to consider contacting a GP 1.7 (1.1-2.5, p < .05). Both the NESB patients and the ESB-NBA patients were far more likely than ESB-BA patients to report that they had visited the ED either because they do not have a GP (OR 7.9, 95% CI 4.7-13.4, p < .001) and 2.2 (95% CI 1.1-4.4, p < .05) respectively and less likely to think that the ED could deal with their problem better than a GP (OR 0.5 (95% CI 0.3-0.8, p < .05) and 0.7 (0.3-0.9, p < .05) respectively. The NESB patients also thought it would take too long to make an appointment to consult a GP (OR 6.2, 95% CI 3.7-10.4, p < 0.001).
  
  
  CONCLUSIONS
  NESB patients were the least likely to consider contacting a GP before attending hospital EDs. Educational interventions may help direct NESB people to the appropriate health services and therefore reduce the burden on tertiary hospitals ED.
authors.affiliation: Department of Emergency Medicine, Royal Brisbane & Women's Hospital - School of Medicine, The University of Queensland, and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia. tabat214@gmail.com.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Mahmoud
authors.affiliation: School of Medicine and the Department of Emergency Medicine- Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia. r.eley@uq.edu.au.
authors.forename: Rob
authors.initials: R
authors.lastname: Eley
authors.affiliation: School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia. x.hou@qut.edu.au.
authors.forename: Xiang-Yu
authors.initials: XY
authors.lastname: Hou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D058006:General Practice; D019538:Health Care Surveys; D006801:Humans; D007802:Language; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data; D011793:Queensland; D012959:Socioeconomic Factors; D014218:Triage; D055815:Young Adult