NON-URGENT CARE IN THE HOSPITAL MEDICAL EMERGENCY DEPARTMENT IN FRANCE - HOW MUCH AND WHICH HEALTH NEEDS DOES IT REFLECT

Objectives - The goal was to describe the use of the medical emergency department as a source of non-urgent medical care in order to assess unmet health care needs among its users. The specific objectives were thus to assess the proportion of department visits for non-urgent medi cal care and to describe those who used the department for this reason , Design - A cross sectional study was performed at the emergency depa rtment in two hospitals (around 12 000 visits per year each). Subjects were interviewed before and after the visit using a standardised ques tionnaire. Setting - The medical emergency departs ment of two univers ity hospitals, one in Paris and one in Besancon (France). Subjects - E ach patient aged 15 and more attending the emergency department for a visit during 40 randomly selected periods of 12 hours was included, Ma in outcome measures - A definition of urgent care was adopted before t he beginning of the study, Four expert judgments were then used for ea ch case to determine whether the reason for the visit was urgent or no t, Results - Altogether 594 patients in the Paris emergency department and 614 in the Besancon one were included, in Besancon, the patients were alder, a general practitioner was more often cited as the regular source of care, and the percentage of subsequent hospital admission w as higher than in Paris (71% versus 34%). The non-urgent visits were e stimated to account for 35% and 29% of the visits in Paris and Besanco n respectively. Patients using the emergency department for a non-urge nt visit were younger than other patients, More of them were unemploye d, homeless, born outside of France, and without health insurance, Con clusions - Non-urgent use of the emergency department was observed in about one third of the visits. Groups using the department for primary care and/or non-urgent care were mostly young and socially fragile, w ith no regular source of health care, Their poor health condition sugg ests that there is a need for a structure providing primary care both inside and outside 'normal' working hours.