Nonurgent Emergency Department (ED) Visits: Patient Characteristics and Barriers to Primary Care

BACKGROUND: ED overcrowding is at the forefront of the medical and political agendas and diversion of nonurgent (NU) patients (pts) has been entertained as a management strategy. Prior to policy changes a clear understanding of the reasons why these pts are not seeking care at a primary care provider (PCP) before presenting to the ED is essential. This study compares NU pts to urgent and semi-urgent (USU) and describes the NU pt reasons for not seeking care at a PCP before presenting to the ED. METHODS: Cross-sectional study with sequential sampling in 5 tertiary care hospitals EDs (Oct. 19 1999 to May 26 2000). Data on past medical history, social support, awareness and utilization of healthcare, ED visit, referral, Activities of Daily Living (ADL), socio-demographics, were obtained. The NU group were pts triaged as code 5 while USU were pts coded 2,3,4 using the Canadian Triage & Acuity Scale. Pts reasons were structured into the Andersen Behavioral Model (ABM) for health care utilization. Only comparisons producing P-value < 0.05 are shown. RESULTS: Of 2348 pts approached 1804 (76%) accepted to participate. NU (n = 454) were younger than USU (n = 1329) (mean age 43 vs. 49 years). NU pts had better health (number of prior conditions; 3.1 vs 2.87) and functioning (ADLs;1.92 vs 1.87), were less likely to arrive by ambulance (4% vs 22%), reported less specialist care (38% vs 48%) and were less often admitted from the ED (4% vs 24%). While 70% of NU pts compared to 75% USU pts were followed by a PCP, only 22% of NU pts and 27% USU pts sought PCP care before presenting to the ED. The reasons given by NU pts for not seeking PCP care were: accessibility (34%), referral/follow-up to the ED (19%), familiarity with (19%), perception of need (16%), and trust of the ED (10%). CONCLUSIONS: The NU pt clientele is a heterogeneous group and that there are significant issues to be considered prior to implementation of diversion strategies.