[Doctor, I come from emergency service!]

To identify the risk factors responsible for the high demand for care from patients coming via casualty to the general medicine and paediatrics clinics at our health centre.

Observational study.

Primary care. Panaderas II Health Centre, Madrid.

All the patients attending the paediatrics and/or general medicine clinic via casualty in October 1996 were included (636). At random, 209 patients were selected from those who attended on demand.

For each patient the following variables were gathered: emergency/appointment, age, sex, room assigned, whether they asked for appointment, hour of call, type of emergency, clinic where seen, delay in appointment, assigned to which doctor's list, paediatrician/general practitioner. Being a girl was a significant risk factor in paediatrics casualty. In general practice, belonging to clinics with longer waits for an appointment and more patients per doctor (OR > 2) brought a higher risk, though not significantly, of attendance for consultation via casualty. Young people attended more frequently via casualty (chi 2 = 6.55, p = 0.01).

The increase in each doctor's patient list generates attendance overload and anomalous paths for consultation. Limiting accessibility of the population does not control demand and increases the route via casualty. The doctor should assess personally those urgent requests not controlled by the clerical staff. Special attention to the young is probably needed to find the causes of the increase in emergency consultations among this population group.