title: Primary care and public emergency department overcrowding.
abstract: OBJECTIVE
  Our objective was to evaluate whether referral to primary care settings would be clinically appropriate for and acceptable to patients waiting for emergency department care for nonemergency conditions.
  
  
  METHODS
  We studied 700 patients waiting for emergency department care at a public hospital. Access to alternative sources of medical care, clinical appropriateness of emergency department use, and patients' willingness to use nonemergency services were measured and compared between patients with and without a regular source of care.
  
  
  RESULTS
  Nearly half (45%) of the patients cited access barriers to primary care as their reason for using the emergency department. Only 13% of the patients waiting for care had conditions that were clinically appropriate for emergency department services. Patients with a regular source of care used the emergency department more appropriately than did patients without a regular source of care. Thirty-eight percent of the patients expressed a willingness to trade their emergency department visit for an appointment with a physician within 3 days.
  
  
  CONCLUSIONS
  Public emergency departments could refer large numbers of patients to appointments at primary care facilities. This alternative would be viable only if the availability and coordination of primary care services were enhanced for low-income populations.
authors.affiliation: Department of Family and Community Medicine, San Francisco General Hospital, CA 94110.
authors.forename: K
authors.initials: K
authors.lastname: Grumbach
authors.forename: D
authors.initials: D
authors.lastname: Keane
authors.forename: A
authors.initials: A
authors.lastname: Bindman
mesh_terms: D000328:Adult; D001290:Attitude; D003441:Crowding; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000523:psychology; D011320:Primary Health Care; D012017:Referral and Consultation; D012495:San Francisco