title: Factors associated with choosing the emergency department as the primary access point to health care: a Canadian population cross-sectional study.
abstract: OBJECTIVE
  Approximately 4.3 million Canadians are without a primary care physician, of which 13% choose the emergency department (ED) as their regular access point to health care. We sought to identify factors associated with preferential ED use over other health services. We hypothesized that socioeconomic barriers (i.e., employment, health status, education) to primary care would also prevent access to ED alternatives.
  
  
  METHODS
  Data from the Canadian Community Health Survey, 2007 to 2008, were analysed (N=134,073; response rate 93.5%). Our study population comprised 14,091 individuals identified without a primary care physician. Socioeconomic variables included employment, health, and education. Covariates included chronic health conditions, immigrant status, gender, age, and mental health. Prevalence estimates and 95% confidence intervals (CIs) for each variable were calculated. Weighted logistic regression models were constructed to evaluate the importance of individual risk factors and their interactions after adjustment for relevant covariates.
  
  
  RESULTS
  The sample comprised 57.2% males from across Canada. Employment (OR 0.73 [95% CI: 0.59-0.90]), good health (OR 0.73 [95% CI 0.57-0.88]), and post-secondary education (OR 0.68 [95% CI 0.53-0.88]) reduced respondents use of the ED. The reduced odds of ED use were independent of chronic conditions, mental health, gender, poor mobility, province, and age.
  
  
  CONCLUSIONS
  Low socioeconomic status dictates preferential ED use in those without a primary care physician. Specific policy and system development targeting this at-risk population are indicated to alter ED use patterns in this population.
authors: *Department of Emergency Medicine and the School of Epidemiology,Public Health and Preventive Medicine,The University of Ottawa,Ottawa Hospital Research Institute,Ottawa,ON.
authors: Robert
authors: R
authors: Ohle
authors: †Royal College of Surgeons in Ireland,Dublin,Ireland.
authors: Michelle
authors: M
authors: Ohle
authors: *Department of Emergency Medicine and the School of Epidemiology,Public Health and Preventive Medicine,The University of Ottawa,Ottawa Hospital Research Institute,Ottawa,ON.
authors: Jeffrey J
authors: JJ
authors: Perry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada; 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 / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D011320:Primary Health Care
keywords: emergency department; primary care; survey