Self-referrals to the A&E department during out-of-hours: patients' motives and characteristics.
OBJECTIVE
To determine self-referrals' motives to visit the accident & emergency departments (AED) and to compare their characteristics to patients contacting the GP cooperative.


METHODS
Postal questionnaires were send to AED self-referrals and logistic regression analysis was used to contrast self-referrals to patients contacting the GP cooperative.


RESULTS
For a study population of 62,000, during 4 months, 5547 contacts were registered with the GP cooperative, along with 808 AED contacts, 344 of whom (43%) were self-referrals. Main reasons to visit the AED were the perceived need for diagnostic facilities and the conviction that the hospital specialist was best qualified to handle the problem. Dissatisfaction with the GP cooperative among respondents was high. Self-referral to the AED was positively associated with injury, age between 15 and 64, musculoskeletal, cardiovascular and respiratory problems, and distance to the GP centre.


CONCLUSIONS
Self-referrals emerge as patients with a strong preference for the AED, mainly based on assumptions on quality of care and necessary facilities.


CONCLUSIONS
While self-referrals may, in part, make motivated and appropriate choices to visit the AED, new integrated care models should be studied that can adequately deflect those who are eligible for GP care.
Department of General Practice, Academic Medical Centre-University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands. e.p.mollvancharante@amc.uva.nl
Eric Peter
EP
Moll van Charante
Gerben
G
ter Riet
Patrick
P
Bindels
D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data*; D000367:Age Factors; D002755:Choice Behavior; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005194:Family Practice / Q000458:organization & administration; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006300:Health Services Misuse; D006301:Health Services Needs and Demand; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009042:Motivation; D009426:Netherlands; D015404:Nursing Methodology Research; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D036301:Qualitative Research; D012017:Referral and Consultation; D011795:Surveys and Questionnaires