CoChat
Sign Up
Cited by 87Emergency and Acute Care StudiesPrimary Care and Health OutcomesHealthcare Systems and Technology

Factors predicting patient use of the emergency department: a retrospective cohort study

Open access
McCusker, Jane, Tousignant, Pierre, Silva, Roxane Borgès Da, Ciampi, Antonio, Lévesque, Jean-Frédéric, Vadeboncoeur, Alain, Sanche, Steven·2012·Canadian Medical Association Journal
DOI 10.1503/cmaj.111069PMC PMC3314059
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Many studies have shown the tendency for people without a regular care provider or primary physician to make greater use of emergency departments. We sought to determine the effects of three aspects of care provided by primary physicians (physician specialty, continuity of care and comprehensiveness of care) on their patients' use of the emergency department. METHODS: Using provincial administrative databases, we created a cohort of 367,315 adults aged 18 years and older. Participants were residents of urban areas of Quebec. Affiliation with a primary physician, the specialty of this physician (i.e., family physician v. specialist), continuity of care (as measured using the Usual Provider Continuity index) and comprehensiveness of care (i.e., number of complete annual examinations) were measured among participants (n = 311,701) who had visited a physician three or more times during a two-year baseline period. We used multivariable negative binomial regression to investigate the relationships between measures of care and the number of visits to emergency departments during a 12-month follow-up period. RESULTS: Among participants under 65 years of age, emergency department use was higher for those not affiliated than for those affiliated with a family physician (incidence rate ratio [IRR] 1.11, 95% confidence interval [CI] 1.05-1.16) or a specialist (IRR 1.10, 95% CI 1.04-1.17). Among patients aged 65 years and older, having a specialist primary physician, as opposed to a family physician, predicted increased use of the emergency department (IRR 1.13, 95% CI 1.09-1.17). Greater continuity of care with a family physician predicted less use of the emergency department only among participants who made 25 or more visits to a physician during the baseline period. Greater continuity of care with a specialist predicted less use of the emergency department overall, particularly among participants with intermediate numbers of multimorbidities and admissions to hospital. Greater comprehensiveness of care by family physicians predicted less use of the emergency department. INTERPRETATION: Efforts to increase the proportion of adults affiliated with a family physician should target older adults, people who visit physicians more frequently and people with multiple comorbidities and admissions to hospital.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1503/cmaj.111069

Cites

29 of 29 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Patients without a regular primary care provider often experience access barriers, lower continuity of care, less comprehensive care, a lack of care coordination, more unmet needs, and often rely on walk-in clinics and emergency departments.

    “Conversely, patients without a regular primary care provider often experience access barriers, lower continuity of care, less comprehensive care, a lack of care coordination, more unmet needs, and often rely on walk-in clinics and emergency departments, where care can be suboptimal, particularly for patients with complex needs [2, 7, 18–21].”

    From Improved access to and continuity of primary care after attachment to a family physician: longitudinal cohort study on centralized waiting lists for unattached patients in Quebec, Canada (2022) · cites this paper as [21]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Petersen LA, Burstin HR, O'Neil AC, et al. Nonurgent emer- gency department visits: the effect of having a regular doctor. Med Care 1998;36:1249-55.
  2. Stata Corp LP. Stata release 10: user's guide. College Station (TX): Stata Press LP; 2007.

Cited by

Sorted by citations

Related

Authors
McCusker, J., Tousignant, P., Silva, R. B. D., Ciampi, A., Lévesque, J.-F., Vadeboncoeur, A., & Sanche, S.
Affiliations
Montreal Heart Institute (CA)
ORCID
Venue
Canadian Medical Association Journal
Publisher
CMA Joule Inc.
Published
2012-02-21
Volume
184
Issue
6
Pages
E307-E316
ISSN
  • 0820-3946 (ISSN-L)
  • 1488-2329
DOI
10.1503/cmaj.111069
PMC
PMC3314059
OpenAlex
W2169321386
Cited by
87
References
29
Citations by year
2026: 2 · 2025: 3 · 2024: 3 · 2023: 8 · 2022: 7 · 2021: 8 · 2020: 5 · 2019: 6 · 2018: 3 · 2017: 10 · 2016: 5 · 2015: 4 · 2014: 13 · 2013: 9 · 2012: 1
FWCI
9.61
Type
journal article
Language
en
Open access
Locations
  • Canadian Medical Association Journal (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Canadian Institutes of Health Research
Topics
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
Keywords
emergency department utilization, primary care, continuity of care, comprehensiveness of care, general practitioners, specialist physicians, annual physical examination, multimorbidity, hospitalization, older adults, health care utilization
MeSH terms
Adolescent, Adult, Age Factors, Aged, Comprehensive Health Care, Continuity of Patient Care, Emergency Service, Hospital, Family Practice, Female, Humans, Male, Middle Aged, Primary Health Care, Quebec, Regression Analysis, Retrospective Studies, Specialization, Cohort Studies, Multivariate Analysis, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review