Inappropriate Emergency Department Research Articles

Why patients self-refer to the Emergency Department: A qualitative interview study.

There have been multiple studies investigating reasons for patients to self-refer to the Emergency Department (ED). The majority made use of questionnaires and excluded patients with urgent conditions. The goal of this qualitative study is to explore what motives patients have to self-refer to an ED, also including patients in urgent triage categories. In a large teaching hospital in the Netherlands, a qualitative interview study focusing on reasons for self-referring to the ED was performed. Self-referred patients were included until no new reasons for attending the ED were found. Exclusion criteria were as follows: not mentally able to be interviewed or not speaking Dutch. Patients who were in need of urgent care were treated first, before being asked to participate. Interviews followed a predefined topic guide. Practicing cyclic analysis, the interview topic guide was modified during the inclusion period. Interviews were recorded on an audio recorder, transcribed verbatim, and anonymized. Two investigators independently coded the information and combined the codes into meaningful clusters. Subsequently, these were categorized into themes to build a framework of reasons for self-referral to the ED. Characteristic quotes were used to illustrate the acquired theoretical framework. Thirty self-referred patients were interviewed. Most of the participants were male (63%), with a mean age of 46years. Two main themes emerged from the interviews that are pertinent to the patients' decisions to attend the ED: (1) health concerns and (2) practical issues. This study found that there are 2 clearly distinctive reasons for self-referral to the ED: health concerns or practical motives. Self-referral because of practical motives is probably most suitable for strategies that aim to reduce inappropriate ED visits.

The ED use and non-urgent visits of elderly patients

ObjectiveTo evaluate the use of the emergency department (ED) by elderly patients, their non-urgent visits and the prevalence of main disease for ED visits. MethodsThis cross-sectional study was conducted on patients aged 65 years and over who visited the ED of a tertiary care university hospital in Turkey between January 2015 and January 2016 retrospectively. ResultsA total of 36,369 elderly patients who visited the ED were included in the study. The rate of ED visits by elderly patients was higher than their representation within the general population (p < 0.001). While the rate of elderly patients visiting polyclinics was 15.8%, the rate of elderly patients visiting the ED was 24.3% (p < 0.001). For both genders, the rates of ED visits for patients between 65 and 74 years old was higher than for other elderly age groups (p < 0.001). The prevalence of upper respiratory tract infection (URTI) was the highest within the elderly population (17.5%, CI: 17.1–17.9). The proportion of ED visits for non-urgent conditions was 23.4%. Most of the ED visits were during the non-business hours (51.1%), and they were highest in the winter season (25.9%) and in January (10.2%). The hospitalization rate was 9.4%, and 37.9% of hospitalized patients were admitted to intensive care units. ConclusionThe proportion of ED visits by elderly patients was higher than their representation within the general population. Elderly patients often visited the ED instead of a polyclinic. The rate of inappropriate ED use by elderly patients in this hospital was higher than in other countries.

Can improved specialty access moderate emergency department overuse?: Effect of neurology appointment delays on ED visits.

Delayed access to specialty care may increase inappropriate emergency department (ED) visits. However, the details of this relationship after referral to a specialist are unknown. The correlations in an academic medical center between time to new neurology patient appointments and nonurgent ED use are explored in this study. Access was measured as the number of days between the scheduling and outpatient appointment dates. A series of statistical analyses including correlation analysis, regressions, and hypothesis tests were conducted to investigate possible associations between delayed access to specialty care and ED visits, as well as the effect of ED visits on specialty care cancellation and no-show rates. Of 19,505 new neurology patients, 310 visited an ED prior to their appointment, 95.2% (295) of whom had poor access (defined here as exceeding 21 days). Patients with access >21 days for new visits were 6.6 times more likely to visit the ED before their appointment date, 19% within the first week after scheduling. Patients who visited the ED between their booking and appointment dates were 2.3 times more likely to cancel or fail to attend their appointment. These results suggest that long access delays in specialty referrals can significantly increase ED costs and congestion. Further studies in other specialties to explore this relationship are warranted.

Personal Characteristics and Experience of Primary Care Predicting Frequent Use of Emergency Department: A Prospective Cohort Study.

ObjectiveA small number of patients frequently using the emergency department (ED) account for a disproportionate amount of the total ED workload and are considered using this service inappropriately. The aim of this study was to identify prospectively personal characteristics and experience of organizational and relational dimensions of primary care that predict frequent use of ED.MethodsThis study was conducted among parallel cohorts of the general population and primary care patients (N = 1,769). The measures were at baseline (T1), 12 (T2) and 24 months (T3): self-administered questionnaire on current health, health behaviours and primary care experience in the previous year. Use of medical services was confirmed using administrative databases. Mixed effect logistic regression modeling identified characteristics predicting frequent ED utilization.ResultsA higher likelihood of frequent ED utilization was predicted by lower socioeconomic status, higher disease burden, lower perceived organizational accessibility, higher number of reported healthcare coordination problems and not having a complete annual check-up, above and beyond adjustment for all independent variables.ConclusionsPersonal characteristics such as low socioeconomic status and high disease burden as well as experience of organizational dimensions of primary care such as low accessibility, high healthcare coordination problems and low comprehensiveness of care are prospectively associated with frequent ED utilization. Interventions developed to prevent inappropriate ED visits, such as case management for example, should tailor low socioeconomic status and patients with high disease burden and should aim to improve experience of primary care regarding accessibility, coordination and comprehensiveness.

Healthcare use among preschool children attending GP-led urgent care centres: a descriptive, observational study

ObjectiveUrgent care centres’ (UCCs) hours were developed with the aim of reducing inappropriate emergency department (ED) attendances in England. We aimed to examine the presenting complaint and outcomes of care...

Describing team development within a novel GP-led urgent care centre model: a qualitative study

ObjectiveUrgent care centres (UCCs) co-located within an emergency department were developed to reduce the numbers of inappropriate emergency department admissions. Since then various UCC models have developed, including a novel...

Is health systems integration being advanced through Local Health District planning?

Objective Delivering genuine integrated health care is one of three strategic directions in the New South Wales (NSW) Government State Health Plan: Towards 2021. This study investigated the current key health service plan of each NSW Local Health District (LHD) to evaluate the extent and nature of health systems integration strategies that are currently planned. Methods A scoping review was conducted to identify common key principles and practices for successful health systems integration to enable the development of an appraisal tool to content assess LHD strategic health service plans. Results The strategies that are planned for health systems integration across LHDs focus most often on improvements in coordination, health care access and care delivery for complex at-risk patients across the care continuum by both state- and commonwealth-funded systems, providers and agencies. The most common reasons given for integrated activities were to reduce avoidable hospitalisation, avoid inappropriate emergency department attendance and improve patient care. Conclusions Despite the importance of health systems integration and finding that all NSW LHDs have made some commitment towards integration in their current strategic health plans, this analysis suggests that health systems integration is in relatively early development across NSW. What is known about the topic? Effective approaches to managing complex chronic diseases have been found to involve health systems integration, which necessitates sound communication and connection between healthcare providers across community and hospital settings. Planning based on current health systems integration knowledge to ensure the efficient use of scarce resources is a responsibility of all health systems. What does this paper add? Appropriate planning and implementation of health systems integration is becoming an increasingly important expectation and requirement of effective health systems. The present study is the first of its kind to assess the planned activity in health systems integration in the NSW public health system. NSW health districts play a central role in health systems integration; each health service plan outlines the strategic directions for the development and delivery of all state-funded services across each district for the coming years, equating to hundreds of millions of dollars in health sector funding. The inclusion of effective health systems integration strategies allows Local Health Districts to lay the foundation for quality patient outcomes and long-term financial sustainability despite projected increases in demand for health services. What are the implications for practice? Establishing robust ongoing mechanisms for effective health systems integration is now a necessary part of health planning. The present study identifies several key areas and strategies that are wide in scope and indicative of efforts towards health systems integration, which may support Local Health Districts and other organisations in systematic planning and implementation.

Implementation of a hospital-integrated general practice--a successful way to reduce the burden of inappropriate emergency-department use.

Emergency departments (EDs) are overcrowded by lower acuity patients, which might be more efficiently treated by general practitioners (GPs). This study evaluated the impact of triaging lower acuity patients to a new hospital-integrated general practice (HGP) on ED case-load and the reasons for choosing the ED/HGP. Patients were consecutively assessed according to the emergency severity index (ESI) to triage lower acuity patients to the HGP. Consultation numbers at the emergency centre (ED and HGP) increased by 43% between 2007 (n = 16 974) and 2011 (n = 24 331) (implementation of HGP in 2009). Although self-referrals increased significantly at the emergency centre from 54% to 63% (p <0.001), the proportion of self-referrals at the ED was significantly reduced to 48% (p = 0.007). The HGP was able to reduce the burden of increasing total consultations by 36%; 4.6% were referred back to the ED after triaging to the HGP. Overall, 95% of HGP patients were self-referred, Swiss nationals (65%) and with a personal GP (82%) they attended regularly (69%). The most common reason for presenting at the emergency centre was not being able to reach the GP (60%). Diagnoses were injury- (29%) and infection- (23%) related problems affecting the musculoskeletal (27%) system and skin (21%). The HGP succeeded in reducing the burden of inappropriate ED use: the majority of low acuity self-referred patients were conclusively treated at the HGP. The HGP does not represent competition to the GP out-of-hours care service, since the main reason for presenting at the hospital was not lacking a relationship but the GPs' inaccessibility.

Trends in Follow-Up of Patients Presenting to the Emergency Department with Symptomatic Cholelithiasis

Fewer than 25% of Medicare beneficiaries presenting with symptomatic cholelithiasis undergo elective cholecystectomy. To better understand underuse of cholecystectomy, we examined physician follow-up patterns after emergency department (ED) visits for symptomatic gallstones. We used 100% Texas Medicare claims (2001 to 2010) to identify patients 66 years of age and older who presented to the ED with symptomatic cholelithiasis and were discharged home without cholecystectomy. Timing of outpatient physician visits after ED discharge and rates of emergent cholecystectomy based on physician follow-up patterns were compared. In total, 11,126 patients presented to the ED with symptomatic cholelithiasis and were discharged without cholecystectomy. After discharge, 5,327 patients (47.9%) had an outpatient surgeon visit, 29.0% saw another physician and never saw a surgeon, and 23.1% never saw a physician; 68.2% of patients who saw a surgeon underwent elective cholecystectomy; and 8.3% of patients who saw a surgeon, 14.6% of patients who saw other physicians and no surgeon, and 77.6% of patients who never saw any physician, required emergent hospitalization (p < 0.0001). For people who did not see a physician, mean time to emergent hospitalization was 7.5 days (median 2 days); 95.9% presented within 2 weeks after their initial presentation. Fewer than half of patients were evaluated by a surgeon after an initial ED visit for symptomatic gallstones. Patients who did not have physician follow-up were most likely to require emergent cholecystectomy, suggesting inappropriate ED discharge and highlighting the need for timely follow-up. Early outpatient surgical consultation is critical in determining appropriateness for cholecystectomy and avoiding emergent cholecystectomy in older patients with symptomatic gallstones.

Connecting Emergency Department Patients to Primary Care.

Inappropriate emergency department (ED) use among Medicaid enrollees is considered a problem because of cost. We developed and evaluated a system change innovation designed to remove system barriers to primary care access for Medicaid patients. Patients who presented to the ED without an identified primary care provider were randomized to the intervention (n = 72) or comparison group (n = 68) for a 12-month study designed to connect these patients to primary care offices. Evaluation was mixed quantitative/qualitative. Significantly more intervention participants attended at least 1 primary care visit 3 months after the intervention (odds ratio [OR], 2.52; 95% confidence interval [CI], 1.06-6.02), though this difference was not significant by 12 months (OR, 1.74; 95% CI, 0.79-3.84). The intervention participants also did not have lower odds of returning to the ED for nonurgent reasons by the 12-month follow-up (OR, 1.27; 95% CI, 0.65-2.48). Patient-reported barriers to attending a primary care appointment were primarily social and health system-related factors. The intervention did not decrease ED visits nor increase primary care use over the 12 months of the study period. The qualitative results provide insight into nonurgent ED utilization by patients with Medicaid, suggesting potential future interventions.

The Impact of a Student-Run Free Clinic on Reducing Excess Emergency Department Visits

Background: Access to primary care directly impacts inappropriate emergency department (ED) utilization. This relationship has been studied in free clinics, but little work has been done regarding the impact of student-run free clinics (SRFCs). This study investigates the effects of an SRFC in Nashville, Tennessee on reported ED utilization patterns, patient satisfaction with healthcare, and primary care access. Methods: The study population included all patients seen at the 12 South Community Clinic from April 2013 to January 2014. A 7-item paper questionnaire, including items on recent ED usage, satisfaction with current level of healthcare, and access to physicians, was distributed to new patients during their first clinic visit; returning patients received a 5-item follow-up questionnaire. New patient survey responses were compared with returning patient survey responses as aggregate data using unpaired t-tests, and descriptive statistics were used to calculate percentages. Results: The response rate was 94.9% (130/137) for new patients and 83.9% (115/137) for returning patients (N=274). The average reported number of ED visits in a three-month period was 0.47 in new patients and 0.24 in returning patients (p=0.0345). Access to the clinic significantly increased the overall level of healthcare satisfaction from 33.3% (35/105) of patients feeling very or completely satisfied prior to their first visit to the free clinic to 71.8% (79/110) of patients feeling very or completely satisfied on return visit (p&lt;0.0001). Since establishing care at the clinic, 98.2% (112/114) of returning patients reported easier access to a physician.Conclusions: The study design was limited by using data from a quality assurance project; identified, individual-level information was not used, and comparison of individual subject responses was not possible. It is unknown how many individuals may have participated in both or only one group or how many individuals may have repeated data points in the returning patient group. Despite these limitations, results suggest that given ongoing primary care access gaps, SRFCs may serve a role in impacting excess ED utilization, patient satisfaction, and access to care in medically underserved and underinsured populations.

Canadian spine society 15th annual scientific conference.

Canadian spine society 15th annual scientific conference.

The Role of Charity Care and Primary Care Physician Assignment on ED Use in Homeless Patients

ObjectiveHomeless patients are a vulnerable population with a higher incidence of using the emergency department (ED) for noncrisis care. Multiple charity programs target their outreach toward improving the health of homeless patients, but few data are available on the effectiveness of reducing ED recidivism. The aim of this study is to determine whether inappropriate ED use for nonemergency care may be reduced by providing charity insurance and assigning homeless patients to a primary care physician (PCP) in an outpatient clinic setting. MethodsA retrospective medical records review of homeless patients presenting to the ED and receiving treatment between July 2013 and June 2014 was completed. Appropriate vs inappropriate use of the ED was determined using the New York University ED Algorithm. The association between patients with charity care coverage, PCP assignment status, and appropriate vs inappropriate ED use was analyzed and compared. ResultsFollowing New York University ED Algorithm standards, 76% of all ED visits were deemed inappropriate with approximately 77% of homeless patients receiving charity care and 74% of patients with no insurance seeking noncrisis health care in the ED (P=.112). About 50% of inappropriate ED visits and 43.84% of appropriate ED visits occurred in patients with a PCP assignment (P=.019). ConclusionsBoth charity care homeless patients and those without insurance coverage tend to use the ED for noncrisis care resulting in high rates of inappropriate ED use. Simply providing charity care and/or PCP assignment does not seem to sufficiently reduce inappropriate ED use in homeless patients.

Can the NHS survive the winter?

British Journal of NursingVol. 24, No. 1 RegularsCan the NHS survive the winter?Alan GlasperAlan GlasperSearch for more papers by this authorAlan GlasperPublished Online:26 Dec 2014https://doi.org/10.12968/bjon.2015.24.1.56AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Department of Health, Alexander D, Hunt J (2014) NHS well prepared for cold winter pressures. http://tinyurl.com/oy8oq7w (accessed 16 December 2014) Google ScholarElliot AJ, Cross KW, Felming DM (2008) Critical Care Bulletin: Acute respiratory infections and winter pressures on hospital admissions in England and Wales 1990-2005 J Public Health Med 30(1):91–8 Crossref, Google ScholarGlasper A (2014) Should the influenza vaccine be mandatory for frontline staff? Br J Nurs 23(20): 1088–9. doi: https://doi.org/10.12968/bjon.2014.23.20.1088 Link, Google ScholarGoldmann DA (2001) Epidemiology and prevention of pediatric viral respiratory infections in health-care institutions. Emerg Infect Dis 7(2): 249–53 Crossref, Medline, Google ScholarKause J, Fielding R, Arnell-Cullen, Sandeman D (2012) Easing winter pressures. HSJ. 25 October. http://tinyurl.com/n2ned3o (accessed 16 December 2014) Google ScholarKrska J, Morecroft CW (2010) Views of the general public on the role of pharmacy in public health. Journal of Pharmaceutical Health Services Research 1(1): 33–8. doi: https://doi.org/10.1211/jphsr.01.01.0013 Google ScholarLimb M (2014) Increase GP trainees by 450 a year to avoid crisis, says taskforce. BMJ 349: g4799. doi: https://doi.org/10.1136/bmj.g4799 Crossref, Google ScholarNHS Choices (2014) Feeling under the weather this winter? http://tinyurl.com/ojrnykk (accessed 17 December 2014) Google ScholarNHS England (2013) Transforming urgent and emergency care services in England. http://tinyurl.com/prx9qtg (accessed 17 December 2014) Google ScholarNHS England (2014a) Winter Daily Situation Reports. http://tinyurl.com/nbtzyaa (accessed 16 December 2014) Google ScholarNHS England (2014b) Feeling under the weather? http://tinyurl.com/mqwms9f (accessed 16 December 2014) Google ScholarNHS England (2014c) Transforming urgent and emergency care services in England. Update on the Urgent and Emergency Care Review. http://tinyurl.com/mqt4lpb (accessed 17 December 2014) Google ScholarPatton GG, Thakore S (2013) Reducing inappropriate emergency department attendances—a review of ambulance service attendances at a regional teaching hospital in Scotland. Emerg Med J 30(6): 459–61. doi: https://doi.org/10.1136/emermed-2012-201116. Epub 2012 Crossref, Medline, Google ScholarSalisbury C (2007) NHS walk-in centres. BMJ 334(7598): 808–809 doi: http://dx.doi.org/10.1136/bmj.39169.475405.80 Google ScholarSparrow A (2014) George Osborne under fire over £2bn NHS pledge. The Guardian. 30 November. http://tinyurl.com/ncd22jv (accessed 16 December 2014) Google ScholarTurner J, O'Cathain A, Knowles E, Nicholl J (2013) Impact of the urgent care telephone service NHS 111 pilot sites: a controlled before and after study. BMJ Open 3(11): e003451. doi: https://doi.org/10.1136/bmjopen-2013-003451 Crossref, Google ScholarWatt H (2014) NHS is ‘under pressure’, admits David Cameron. The Telegraph (online). 26 November 2014. http://tinyurl.com/ov2nqk8 (accessed 16 December 2014) Google Scholar FiguresReferencesRelatedDetails 8 January 2015Volume 24Issue 1ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 26 December 2014 Published in print 8 January 2015 Information© MA Healthcare LimitedPDF download

The urban homeless: super-users of the emergency department.

In the United States, patient usage of costly emergency departments (EDs) has been portrayed as a major factor contributing to health care expenditures. The homeless are associated with ED frequent users, a population often blamed for inappropriate ED use. This study examined the characteristics and costs associated with homeless ED frequent users. A retrospective cross-sectional review of hospital records for ED visits in 2006 at an urban academic medical center was performed. Frequent users were defined as having greater than 4 ED visits in one year. Homeless status was determined by self-report and review by an interdisciplinary team. A total of 5440 (8.9%) ED visits were made by 542 frequent users, 74 (13.7%) of whom were homeless and made 845 ED visits. Homeless frequent users had a median age of 47 years (39-56 interquartile range), were predominantly male (85.1%), and insured by Medicaid (59.5%). Most (44.2%) visits by homeless frequent users occurred between 1500-2259 hours and had an Emergency Severity Index of Level 3 (55.5%). Sixty-four percent of visits resulted in homeless patients being discharged back to the street; only 4.0% had a specific discharge plan addressing homelessness. Total charges and payments for all homeless frequent users were $4,812,615 and $802,600, respectively. The single top frequent user accrued charges of $482,928. ED frequent users are disproportionately homeless and their costs are significant. ED discharge planning should address the additional risks faced by homeless individuals. ED-based interventions that specifically target the most expensive homeless frequent users may prove to be cost-effective.

The burden of inappropriate emergency department pediatric visits: why Italy needs an urgent reform.

To better understand the issue of inappropriate pediatric Emergency Department (ED) visits in Italy, including the impact of the last National Health System reform. A retrospective cohort study was conducted with five health care providers in the Veneto region (Italy) in a 2-year period (2010-2011). ED visits were considered "inappropriate" by evaluating both nursing triage and resource utilization, as addressed by the Italian Ministry of Health in 2007. Factors associated with inappropriate ED visits were identified. The cost of each visit was calculated. In total, 134,358 ED visits with 455,650 performed procedures were recorded in the 2-year period; of these, 76,680 (57.1 percent) were considered inappropriate ED visits. Patients likely to make inappropriate ED visits were younger, female, visiting the ED during night or holiday, when the primary care provider (PCP) is not available. The National Health System reform aims to improve efficiency, effectiveness, and costs by opening PCP offices 24hours a day and 7days a week. This study highlights the need for a deep reorganization of the Italian Primary Care System not only providing a larger time availability but also treating the parents' lack of education on children's health.

Reducing inappropriate accident and emergency department attendances:

Inappropriate attendances may account for up to 40% of presentations at accident and emergency (A&E) departments. There is considerable interest from health practitioners and policymakers in interventions to reduce this burden. To review the evidence on primary care service interventions to reduce inappropriate A&E attendances. Systematic review of UK and international primary care interventions. Studies published in English between 1 January 1986 and 23 August 2011 were identified from PubMed, the NHS Economic Evaluation Database, the Cochrane Collaboration, and Health Technology Assessment databases. The outcome measures were A&E attendances, patient satisfaction, clinical outcome, and intervention cost. Two authors reviewed titles and abstracts of retrieved results, with adjudication of disagreements conducted by the third. Studies were quality assessed using the Scottish Intercollegiate Guidelines Network checklist system where applicable. In total, 9916 manuscripts were identified, of which 34 were reviewed. Telephone triage was the single best-evaluated intervention. This resulted in negligible impact on A&E attendance, but exhibited acceptable patient satisfaction and clinical safety; cost effectiveness was uncertain. The limited available evidence suggests that emergency nurse practitioners in community settings and community health centres may reduce A&E attendance. For all other interventions considered in this review (walk-in centres, minor injuries units, and out-of-hours general practice), the effects on A&E attendance, patient outcomes, and cost were inconclusive. Studies showed a negligible effect on A&E attendance for all interventions; data on patient outcomes and cost-effectiveness are limited. There is an urgent need to examine all aspects of primary care service interventions that aim to reduce inappropriate A&E attendance.

Medical Group Practice Characteristics Influencing Inappropriate Emergency Department and Avoidable Hospitalization Rates

The inappropriate use of emergency departments (EDs) and ambulatory care sensitive hospital admission rates by patients attributed to a national sample of 212 medical group practices is documented, and the characteristics of practices that influence these rates are identified. Hospital-owned practices have higher nonemergent and emergent primary care treatable ED rates and higher ambulatory care sensitive hospitalization rates. Practices with electronic health records have lower inappropriate ED rates but those in rural areas have significantly higher rates. Practices with lower operating costs have higher inappropriate ED and ambulatory care sensitive rates, raising questions about the costs of preventing these incidents at the medical group practice level.

Commentary on Medical Group Practice Characteristics Influencing Inappropriate Emergency Department and Avoidable Hospitalization Rates

Commentary on Medical Group Practice Characteristics Influencing Inappropriate Emergency Department and Avoidable Hospitalization Rates

The impact of neighborhood deprivation on patients' unscheduled out-of-hours healthcare seeking behavior: a cross-sectional study.

BackgroundThe use of unscheduled out of hours medical care is related to the social status of the patient. However, the social variance in the patient’s preference for a hospital based versus a primary care based facility, and the impact of specific patient characteristics such as the travel distance to both types of facilities is unclear. This study aims to determine the social gradient in emergency care seeking behavior (consulting the emergency department (ED) in a hospital or the community-based Primary Care Center (PCC)) taking into account patient characteristics including the geographical distance from the patient’s home to both services.MethodsA cross-sectional study, including 7,723 patients seeking out-of-hours care during 16 weekends and 2 public holidays was set up in all EDs and PCCs in Ghent, Belgium. Information on the consulted type of service, and neighborhood deprivation level was collected, but also the exact geographical distance from the patient’s home to both types of services, and if the patient has a regular GP.ResultsPatients living in a socially deprived area have a higher propensity to choose a hospital-based ED than their counterparts living in more affluent neighborhoods. This social difference persists when taking into account distance to both services, having a regular GP, and being hospitalized or not. The impact of the distance between the patient’s home address and the location of both types of services on the patient’s choice of service is rather small.ConclusionsInitiatives aiming to lead patients more to PCC by penalizing inappropriate ED use might increase health inequity when they are not twinned with interventions improving the access to primary care services and tackling the underlying mechanisms of patients’ emergency care seeking behavior. Further research exploring the impact of out-of-hours care organization (gatekeeping, payment systems, …) and the patient’s perspectives on out-of-hours care services is needed.