title: The impact of neighborhood deprivation on patients' unscheduled out-of-hours healthcare seeking behavior: a cross-sectional study.
abstract: BACKGROUND
  The use of unscheduled out of hours medical care is related to the social status of the patient. However, the social variance in the patient's preference for a hospital based versus a primary care based facility, and the impact of specific patient characteristics such as the travel distance to both types of facilities is unclear. This study aims to determine the social gradient in emergency care seeking behavior (consulting the emergency department (ED) in a hospital or the community-based Primary Care Center (PCC)) taking into account patient characteristics including the geographical distance from the patient's home to both services.
  
  
  METHODS
  A cross-sectional study, including 7,723 patients seeking out-of-hours care during 16 weekends and 2 public holidays was set up in all EDs and PCCs in Ghent, Belgium. Information on the consulted type of service, and neighborhood deprivation level was collected, but also the exact geographical distance from the patient's home to both types of services, and if the patient has a regular GP.
  
  
  RESULTS
  Patients living in a socially deprived area have a higher propensity to choose a hospital-based ED than their counterparts living in more affluent neighborhoods. This social difference persists when taking into account distance to both services, having a regular GP, and being hospitalized or not. The impact of the distance between the patient's home address and the location of both types of services on the patient's choice of service is rather small.
  
  
  CONCLUSIONS
  Initiatives aiming to lead patients more to PCC by penalizing inappropriate ED use might increase health inequity when they are not twinned with interventions improving the access to primary care services and tackling the underlying mechanisms of patients' emergency care seeking behavior. Further research exploring the impact of out-of-hours care organization (gatekeeping, payment systems, …) and the patient's perspectives on out-of-hours care services is needed.
authors.affiliation: Department of Family Medicine and Primary Health Care, Ghent University, 9000 Ghent, Belgium. Sara.Willems@ugent.be.
authors.forename: Sara
authors.initials: S
authors.lastname: Willems
authors.forename: Wim
authors.initials: W
authors.lastname: Peersman
authors.forename: Philippe
authors.initials: P
authors.lastname: De Maeyer
authors.forename: Walter
authors.initials: W
authors.lastname: Buylaert
authors.forename: Jan
authors.initials: J
authors.lastname: De Maeseneer
authors.forename: Peter
authors.initials: P
authors.lastname: De Paepe
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data*; D000368:Aged; D001530:Belgium; D002648:Child; D002675:Child, Preschool; D003151:Community Health Centers / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011203:Poverty; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012923:Social Class; D014505:Urban Population; D055815:Young Adult
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