Accessible and continuous primary care may help reduce rates of emergency department use. An international survey in 34 countries.
BACKGROUND
Part of the visits to emergency departments (EDs) is related to complaints that may well be treated in primary care.


OBJECTIVE
(i) To investigate how the likelihood of attending an ED is related to accessibility and continuity of primary care. (ii) To investigate the reasons for patients to visit EDs in different countries.


METHODS
Data were collected within the EU Seventh Framework project Quality and Costs in Primary Care (QUALICOPC) in 31 European countries, Australia, New Zealand and Canada. The data were collected between 2011 and 2013 and contain survey data from 60991 patients and 7005 GPs, within 7005 general practices.


METHODS
whether the patient visited the ED in the previous year (yes/no). Multilevel logistic regression analyses were carried out to analyse the data.


RESULTS
Some 29.4% had visited the ED in the past year. Between countries, the percentages varied between 18% and 40%. ED visits show a significant and negative relation with better accessibility of primary care. Patients with a regular doctor who knows them personally were less likely to attend EDs. Only one-third of all patients who visited an ED indicated that the main reason for this was that their complaint could not be treated by a GP.


CONCLUSIONS
Good accessibility and continuity of primary care may well reduce ED use. In some countries, it may be worthwhile to invest in more continuous relationships between patients and GPs or to eliminate factors that hamper people to use primary care (e.g. for costs or travelling).
National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, Department of Social Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam and Michael.van.den.berg@rivm.nl.
Michael J
MJ
van den Berg
National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, Scientific Institute for Quality of Healthcare (114), Radboud University Medical Center, Nijmegen 6500 HB, The Netherlands.
Tessa
T
van Loenen
Scientific Institute for Quality of Healthcare (114), Radboud University Medical Center, Nijmegen 6500 HB, The Netherlands.
Gert P
GP
Westert
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002170:Canada; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005060:Europe; D005260:Female; D058006:General Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D009520:New Zealand; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult
Accident and emergency department; continuity of patient care; emergency medical services; general practice; health services accessibility; primary health care.