title: Walk-ins seeking treatment at an emergency department or general practitioner out-of-hours service: a cross-sectional comparison.
abstract: BACKGROUND
  Emergency Departments (ED) in Switzerland are faced with increasing numbers of patients seeking non-urgent treatment. The high rate of walks-ins with conditions that may be treated in primary care has led to suggestions that those patients would best cared for in a community setting rather than in a hospital. Efficient reorganisation of emergency care tailored to patients needs requires information on the patient populations using the various emergency services currently available. The aim of this study is to evaluate the differences between the characteristics of walk-in patients seeking treatment at an ED and those of patients who use traditional out-of-hours GP (General Practitioner) services provided by a GP-Cooperative (GP-C).
  
  
  METHODS
  In 2007 and 2009 data was collected covering all consecutive patient-doctor encounters at the ED of a hospital and all those occurring as a result of contacting a GP-C over two evaluation periods of one month each. Comparison was made between a GP-C and the ED of the Waid City Hospital in Zurich. Patient characteristics, time and source of referral, diagnostic interventions and mode of discharge were evaluated. Medical problems were classified according to the International Classification of Primary Care (ICPC-2). Patient characteristics were compared using non-parametric tests and multiple logistic regression analysis was applied to investigate independent determinants for contacting a GP-C or an ED.
  
  
  RESULTS
  Overall a total of 2974 patient encounters were recorded. 1901 encounters were walk-ins and underwent further analysis (ED 1133, GP-C 768). Patients consulting the GP-C were significantly older (58.9 vs. 43.8 years), more often female (63.5 vs. 46.9%) and presented with non-injury related medical problems (93 vs. 55.6%) in comparison with patients at the ED. Independent determining factors for ED consultation were injury, male gender and younger age. Walk-in distribution in both settings was equal over a period of 24 hours and most common during daytime hours (65%).Outpatient care was predominant in both settings but significantly more so at the GP-C (79.9 vs. 85.7%).
  
  
  CONCLUSIONS
  We observed substantial differences between the two emergency settings in a non gate-keeping health care system. Knowledge of the distribution of diagnoses, their therapy, of diagnostic measures and of the factors which determine the patients' choice of the ED or the GP-C is essential for the efficient allocation of resources and the reduction of costs.
authors.affiliation: Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland. Corinne.Chmiel@usz.ch
authors.forename: Corinne
authors.initials: C
authors.lastname: Chmiel
authors.forename: Carola A
authors.initials: CA
authors.lastname: Huber
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.forename: Marco
authors.initials: M
authors.lastname: Zoller
authors.forename: Klaus
authors.initials: K
authors.lastname: Eichler
authors.forename: Patrick
authors.initials: P
authors.lastname: Sidler
authors.forename: Oliver
authors.initials: O
authors.lastname: Senn
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data*; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013557:Switzerland; D013997:Time Factors