Why 'primary care' patients go to emergency departments: demographic profile and reasons for presentation

This paper investigates why (potential) primary care patients attend an ED rather than a GP. An understanding of why patients make decisions such as this is critical if the health system is to be better positioned to meet the increasing demand for improved services and outcomes. We found that the rate of potential primary care presentations varies greatly by age and by sex and that the pattern of primary care presentations is different to that of other ED presentations. In relation to reasons, we found that, regardless of age or sex, the top three reasons were self-assessed urgency; being able to ‘see the doctor and having tests or X-rays done in the same place’; and self-assessed seriousness or complexity. Older patients in particular were unlikely to give reasons associated with GP affordability or availability for attending an ED. We conclude that primary care presentations in the ED are the result of patients, particularly older people, making active decisions that the ED, and not the GP, provides the service they need. This has important implications for the design of ED services and the likely success of diversionary strategies.