title: Factors associated with the utilization of primary care emergency centers in a Spanish region with high population dispersion: a mixed-methods study.
abstract: BACKGROUND
  Adequate access to primary care emergency centers is particularly important in rural areas isolated from urban centers. However, variability in utilization of emergency services located in primary care centers among inhabitants of nearby geographical areas is understudied. The objectives of this study are twofold: 1) to analyze the association between the availability of municipal emergency care centers and utilization of primary care emergency centers (PCEC), in a Spanish region with high population dispersion; and 2) to determine healthcare providers' perceptions regarding PCEC utilization.
  
  
  METHODS
  A mixed-methods study was conducted. Quantitative phase: multilevel logistic regression modeling using merged data from the 2003 Regional Health Survey of Castile and Leon and the 2001 census data (Spain). Qualitative phase:14 in-depth- interviews of rural-based PCEC providers.
  
  
  RESULTS
  Having PCEC as the only emergency center in the municipality was directly associated with its utilization (p < 0.001). Healthcare providers perceived that distance to hospital increased PCEC utilization, and distance to PCEC decrease its use. PCEC users were considered to be predominantly workers and students with scheduling conflicts with rural primary care opening hours.
  
  
  CONCLUSIONS
  The location of emergency care centers is associated with PCEC utilization. Increasing access to primary care by extending hours may be an important step toward optimal PCEC utilization. Further research would determine whether lower PCEC use by certain groups is associated with disparities in access to care.
authors.affiliation: National School of Public Health, Health Institute Carlos III, Madrid, Spain. bsanz@isciii.es.
authors.forename: Belén
authors.initials: B
authors.lastname: Sanz-Barbero
authors.forename: Laura
authors.initials: L
authors.lastname: Otero-García
authors.forename: Teresa
authors.initials: T
authors.lastname: Blasco-Hernández
authors.forename: Miguel
authors.initials: M
authors.lastname: San Sebastián
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004632:Emergency Medical Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D005260:Female; D006282:Health Personnel; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D036301:Qualitative Research; D019035:Rural Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D013030:Spain; D055815:Young Adult