Alain Davido

Using the hospital emergency department as a regular source of care

Objectives: to evaluate the proportion of the patients who report the emergency department as their regular source of care and to describe the demographics and health status of this population. Design: A cross-sectional study was performed at the emergency department in two hospitals (around 12.000 visits per year each). Subjects were interviewed using a standardised questionnaire, before and after the emergency department visit. Setting: The medical emergency department of two university hospitals, one in Paris and one in Besanìon (France). Subjects: Each patient aged 15 and more attending the emergency department for a visit during forty randomly selected periods of 12 hours was included. Main outcome measures: Self report of the utilization of the emergency department as a regular source of care. Results: Fourteen percent of the patients cited the emergency department as a regular source of care in Paris, and 3.3% in Besanìon. In Paris, young age, being born outside of France, homelessness or precarious housing, lack of social support in case of illness and lack of health insurance were independently associated with his health care utilization behavior. Conclusions: From a public health point of view, the patients reported to use the emergency department as a primary health care structure should not be considered as ‘inappropriate’ or ‘abusers’. Specific health needs have been found, which would require some continuity of care, a task for which the emergency department is not organised nowadays.