title: Having a family doctor was associated with lower utilization of hospital-based health services.
abstract: BACKGROUND
  Primary care in the United States and most countries in Asia are provided by a variety of doctors. However, effectiveness of such diversified primary care in gate-keeping secondary medical services is unknown. This study aimed to evaluate health services utilization rates of hospital emergency and admission services among people who used different primary care doctors in Hong Kong.
  
  
  METHODS
  This study was a population-based cross-sectional telephone survey using structured questionnaire on health services utilization rates and pattern in Hong Kong in 2007 to 2008. Information on the choice of primary care doctors, utilization rates and patterns of primary care service were collected. Poisson and logistic regression analyses were used to explore any differences in service utilization rates and patterns among people using different types of primary care doctors.
  
  
  RESULTS
  Out of 3148 subjects who completed the survey, 1896 (60.2%) had regular primary care doctors, of whom 1150 (60.7%) regarded their regular doctors as their family doctors (RFD). 1157 (36.8%) of them did not use any regular doctors (NRD). Only 4.3% of the RFD group (vs 7.8% of other regular doctors (ORD) and 9.6% of NRD) visited emergency service and only 1.7% (vs 3.6% of ORD and 4.0% of NRD) were admitted to hospital for their last episode of illness. Regression analyses controlling for sociodemographics and health status confirmed that respondents having RFD were less likely to use emergency service than people who had NRD (OR 0.479) or ORD (OR 0.624) or being admitted to hospital (OR 0.458 vs NRD and 0.514 vs ORD) for their last episode of illness.
  
  
  CONCLUSIONS
  Primary care is the most effective in gate-keeping secondary care among people with regular family doctors. People without any regular primary care doctor were more likely to use emergency service as primary care. The findings supported a family doctor-led primary care model.
  
  
  BACKGROUND
  ClinicalTrials.gov ID: NCT01422031.
authors: Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F,, 161 Main Street, Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong. cfsc@hku.hk.
authors: Colman S C
authors: CS
authors: Fung
authors: Carlos K H
authors: CK
authors: Wong
authors: Daniel Y T
authors: DY
authors: Fong
authors: Albert
authors: A
authors: Lee
authors: Cindy L K
authors: CL
authors: Lam
mesh_terms: D000328:Adult; D000368:Aged; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010821:Physicians, Family / Q000706:statistics & numerical data*; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D012044:Regression Analysis
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