Patient perceptions of emergency department versus GP visits and of GPFirst: a qualitative study

Overcrowding in emergency departments (EDs) has long been a concern, contributing to adverse outcomes. To address inappropriate attendances, Changi General Hospital (CGH) introduced GPFirst, a programme that encourages patients with mild conditions to visit general practitioners (GPs) first. This study explored patients' perspectives on ED versus GP visits and their views on GPFirst to guide programme improvement.

Purposive sampling was used to recruit patients who had inappropriately attended the CGH ED and were unaware of GPFirst. Sixteen in-depth interviews were conducted and analysed using thematic analysis.

Four main themes were identified: (1) determinants of health-seeking behaviour; (2) factors driving ED or GP preference; (3) motivations to participate in GPFirst; and (4) barriers to GPFirst uptake with suggestions for improvement. Emergency department visits were influenced by perceived severity or uncertainty of illness, trust in hospital resources, round-the-clock availability, social and financial considerations and prior GP experiences. General practitioners were valued for shorter waiting times, accessibility, personalised care, and lower out-of-pocket costs in some contexts. About half of the participants expressed willingness to use GPFirst, citing financial incentives and civic responsibility, whereas others remained hesitant due to difficulty in self-triaging, low awareness and unclear processes.

This study revealed gaps between drivers of ED attendance and facilitators of GP use. Sustained, multi-pronged strategies, such as improving awareness, clarifying processes, aligning incentives and strengthening confidence in primary care, could help enhance GPFirst adoption and mitigate ED overcrowding.