PATTERNS OF VISITS TO HOSPITAL-BASED EMERGENCY ROOMS

What are the functions of hospital emergency care in our society? How are these functions associated with the characteristics of emergency r oom users, their environment and with other available medical resource s? To answer these questions, an ecological conceptual framework has b een developed, along with a procedure which clearly distinguishes betw een the sources of individual variation (user characteristics) and eco logical variation (the users' environment and available medical resour ces). Four different functions have been identified: (1) care of criti cal or urgent cases requiring treatment only available in a hospital, (2) care of urgent cases requiring treatment also available elsewhere than in a hospital, (3) care of non-urgent cases requiring treatment o nly available in a hospital and (4) care of non-urgent cases requiring treatment also available elsewhere than in a hospital. The ecological units selected for this study do not differ statistically with regard to the frequency with which emergency rooms are used for these four f unctions. However, certain individual factors predicting frequency of utilization do differ depending on the unit; for example, patient heal th status is not uniformly related to the use of emergency rooms for n on-urgent reasons in all units. This association is particularly weak in socio-economically deprived units and more significant at higher so cio-economic levels. (C) 1998 Elsevier Science Ltd. All rights reserve d.