Patient-initiated emergency department visits without primary care follow-up: frequency and characteristics

To estimate the volume of patient-initiated visits to the emergency department without follow-up by a primary care physician, and to identify factors related to this practice.

Retrospective, observational study of patients attended in a tertiary care hospital emergency department. We used a cluster/systematic sampling method to select 0.05% of the episodes discharged home every month. The following data were extracted: demographic variables, care times, prior primary care for the same episode, triage level, diagnosis, cost of prescriptions on discharge, instructions for follow-up, and adherence to those instructions. Associations were explored using multivariate logistic regression modelling.

A total of 1277 episodes were analyzed; 48.1% were patient-initiated visits without primary care follow-up. These visits were associated with the following variables: young patients (P = .002) without prior primary care (odds ratio [OR], 1.74; 95% CI, 1.34-2.28); visits between 10 PM and 4 AM (OR, 2.43; 95% CI, 1.55-3.80); triage level 4-5 (OR, 1.33; 95% CI, 1.04-1.69); ophthalmologic emergency (OR, 1.64; 95% CI, 1.12-2.41); a prescription cost of less than €3 (OR, 2.39; 95% CI, 1.87-3.06); and instruction to seek follow-up on discharge (OR, 1.9; 95% CI, 1.37-2.65).

Half of patients who independently seek care from the emergency department and are discharged home do not later seek care at their primary care clinic. The emergency physician should insist on the importance of ongoing primary care.