Accessible and continuous primary care may help reduce rates of emergency department use. An international survey in 34 countries

Fam Pract. 2016 Feb;33(1):42-50. doi: 10.1093/fampra/cmv082. Epub 2015 Oct 28.


Background: Part of the visits to emergency departments (EDs) is related to complaints that may well be treated in primary care.

Objectives: (i) To investigate how the likelihood of attending an ED is related to accessibility and continuity of primary care. (ii) To investigate the reasons for patients to visit EDs in different countries.

Methods: Data were collected within the EU Seventh Framework project Quality and Costs in Primary Care (QUALICOPC) in 31 European countries, Australia, New Zealand and Canada. The data were collected between 2011 and 2013 and contain survey data from 60991 patients and 7005 GPs, within 7005 general practices.

Outcome measure: whether the patient visited the ED in the previous year (yes/no). Multilevel logistic regression analyses were carried out to analyse the data.

Results: Some 29.4% had visited the ED in the past year. Between countries, the percentages varied between 18% and 40%. ED visits show a significant and negative relation with better accessibility of primary care. Patients with a regular doctor who knows them personally were less likely to attend EDs. Only one-third of all patients who visited an ED indicated that the main reason for this was that their complaint could not be treated by a GP.

Conclusions: Good accessibility and continuity of primary care may well reduce ED use. In some countries, it may be worthwhile to invest in more continuous relationships between patients and GPs or to eliminate factors that hamper people to use primary care (e.g. for costs or travelling).

Keywords: Accident and emergency department; continuity of patient care; emergency medical services; general practice; health services accessibility; primary health care..

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Australia
  • Canada
  • Continuity of Patient Care / statistics & numerical data*
  • Emergency Service, Hospital / statistics & numerical data*
  • Europe
  • Female
  • General Practice
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multilevel Analysis
  • New Zealand
  • Primary Health Care / statistics & numerical data*
  • Surveys and Questionnaires
  • Young Adult