Factors associated with non-urgent utilization of Accident and Emergency services: a case-control study in Hong Kong

Accident and Emergency Departments (A&E) have been a popular source of prim ary care, and studies have shown that up to two thirds of patients attendin g A&E have problems that could be managed by general practitioners (GPs), A lthough many studies have found that patients of lower socio-economic class with less social support have a higher utilization rate of A&E, some recen t studies have revealed contrary evidence. In this study 2410 patients were randomly selected from four A&E at different times. The gold standard in d ifferentiating true emergency cases and GP cases was based on a retrospecti ve record review conducted independently by a panel of emergency physicians . Two emergency physicians reviewed each case independently, and if their i ndependent ratings were in agreement, this became the gold standard. Patien ts classified as GP cases were given a telephone interview, and a sample wa s selected and matched with cases from general out patient clinics (GOPC) i n the public sector by morbidity. Reasons for not attending a private GP in cluded closure of clinic, deterioration of symptoms, GPs' inability to diag nose properly, and patients' wish to continue medical treatment in the same hospital. Reasons why non-urgent patients did not choose to attend the nea rby public GOPC included affordability, closure of the GOPC, patients' wish to continue treatment at the same hospital, GOPC too far away, no improvem ent shown after visits to GOPC doctors, and GOPC doctors' inability to make proper diagnoses. The reasons for high level of utilization of A&E service s are complex and reflect problems of delivery of GP services. There is an urgent need for GPs to set up a network system to provide out of hours serv ices, and also for a better interfacing between primary and secondary care, and between public and private sectors, so that patients can be referred b ack to GPs. Interim clinical services provided to those non-urgent cases by nursing practitioners or by GPs working in A&E could also facilitate disch arge of patients to primary care facilities. (C) 2000 Elsevier Science Ltd. All rights reserved.