BACKGROUND: The overutilization of the hospital emergency areas (HEA)
in recent years has been related to an inadequate functioning of the p
rimary health care and can be corrected by the implementation of the p
rimary health care reform. MATERIAL AND METHODS: Home interview of a s
ample of residents of the city of Mataro (Barcelona, Spain), where the
primary health care reform affects to four of the seven basic health
areas. Collection of information on health care utilization and attitu
des to its use. RESULTS: Of the 1,974 studied subjects 27% (CI 95%, 25
-29) reported to have used the HEA in the former year, and the frequen
cy of visits was 0.48 (CI 95%, 0.44-0.54) per person. For the 1880 ben
eficiaries of the national health system, these results were somewhat
lower between the users of reformed centres (27%, 0.46) than those of
non-reformed centres (30%, 0.50) (p = NS); differences were attributed
mainly to adult women. Users of reformed centres expressed more prefe
rence for the ambulatory in case of a non-severe emergency (37% and 17
%; p < 0.0001) and consulted more often before going to the HEA (17 ac
id 10%; p = 0.03), Among the reasons to go to the HEA, users of the re
formed model perceived less necessity of an immediate action (43 and 5
2%; p = 0.05) and greater time barriers with the basic health areas (2
3 and 15%; p = 0.04). CONCLUSIONS: In spite of the lack of overall dif
ferences in the use of HEA between users of reformed centres and non-r
eformed centres we observed a lower utilization in some age and sex gr
oups from reformed centres. Some elements of the demand of the HEA are
more appropriate and attributed to the primary health care reform. Ho
wever, the reasons prompting to use the HEA show that an unjustified u
tilization is still done, independently of the primary health care mod
el.