Primary care patients' views on why they present to Emergency Departments: Inappropriate attendances or inappropriate policy?

This study investigates why some patients with apparently less urgent conditions present to emergency departments (EDs). We report on a survey of "potential primary-care" ED patients, who were asked about their reasons for choosing the ED over GPs. The sample consisted of 397 patients (with a response rate of 99% = 397/400), recruited in the former Illawarra Health Area. The three main reasons selected 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. The results do not appear to be sensitive to two potential sources of bias (fixed question ordering and non-random sampling). The results suggest a number of potential policy levers for encouraging some people to present to GPs rather than EDs. However, the main conclusion is that the majority of "potential primary-care" patients appear to be presenting for appropriate reasons. Thus "inappropriate attendances" do not seem to be the cause of EDs being under stress. We also argue that the results are useful for drawing inferences more broadly than just in relation to the Illawarra.