Primary care patients in the emergency department: who are they? A review of the definition of the 'primary care patient' in the emergency department.
OBJECTIVE
To review the definition of 'primary care' and 'inappropriate' patients in ED and develop a generally acceptable working definition of a 'primary care' presentation in ED.


METHODS
A Medline review of articles on primary care in ED and the definitions used.


RESULTS
A total of 34 reviewed papers contained a proposed definition or comment on the definition for potential 'primary care', 'general practice', or 'inappropriate' patients in ED. A representative definition was developed premised on the common factors in these papers: low urgency/acuity--triage categories four or five in the Australasian Triage Scale, self-referred--by definition, patients referred by general practitioner/community primary medical services are not primary care cases because a primary care service has referred them on, presenting for a new episode of care (i.e. not a planned return because planned returns are not self-referred), unlikely to be admitted (in the opinion of Emergency Nurse interviewers) or ultimately not admitted.


CONCLUSIONS
This definition can be applied either prospectively or retrospectively, depending on the purpose. Appropriateness must be considered in light of a legitimate role for ED in primary care and the balance of resources between primary care and emergency medicine in local settings.
Bezzina
Andrew J
AJ
Illawarra Area Health, South Coast Mail Centre, University of Wollongong, Wollongong, New South Wales, Australia. bezzinaa@iahs.nsw.gov.au
Smith
Peter B
PB
Cromwell
David
D
Eagar
Kathy
K
D000208:Acute Disease; D001315:Australia; D002170:Canada; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005060:Europe; D005194:Family Practice; D006801:Humans; D010342:Patient Acceptance of Health Care; D010343:Patient Admission; D011320:Primary Health Care / Q000458:organization & administration*; D012107:Research Design; D009626:Terminology as Topic; D014218:Triage / Q000379:methods; D014481:United States