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Can after-hours family medicine clinics represent an alternative to emergency departments?

Survey of ambulatory patients seeking after-hours care

Greg Edgar
Medical student at the University of Ottawa in Ontario

Clare Liddy, MD MSc CCFP FCFP
Clinical Investigator and an Assistant Professor in the Department of Family Medicine at the University of Ottawa and a family physician for the Riverside Family Health Team in Ottawa

Christian Vaillancourt, MD MSc FRCPC
Assistant Professor in the Department of Emergency Medicine at the University of Ottawa, a scientist at the Ottawa Health Research Institute, and an active attending physician in the emergency department at the Ottawa Hospital

Correspondence: Dr Clare Liddy, University of Ottawa, C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, 43 Bruyère St, Ottawa, ON K1N 5C8; e-mailCLiddy{at}bruyere.org

OBJECTIVE To explore patients’ motivations for seeking care in the emergency department (ED) after hours and their willingness to consult their family physicians instead, if their family physicians had been available.

DESIGN Survey using an 8-item questionnaire.

SETTING Two tertiary care hospital EDs in Ottawa, Ont, from June 4 to 22, 2007, between 5 PM and 9 PM.

PARTICIPANTS A total of 151 ambulatory patients. Patients who arrived by ambulance or who bypassed those waiting were excluded.

MAIN OUTCOME MEASURES Patients’ self-reported motivation for seeking after-hours care in the ED, the perceived urgency of their medical complaints, and their willingness to have sought care from their family physicians instead, if they had been available.

RESULTS There were 218 eligible patients during the study period. Among the 151 respondents (69.3% response rate), 141 qualified for the study. Of the qualified respondents, 57.4% would have chosen to consult their family physicians instead if they had been available. The most common reason for choosing the ED was the perceived need for services unavailable at family medicine clinics, such as specialist consultation or diagnostic imaging. There were no differences in the perceived urgency of patients’ medical conditions or the amount of time they were willing to wait before physician assessment between those who would have been willing to seek care from their family physicians and those who would not have been willing.

CONCLUSION After-hour family medicine clinics provide a desirable primary care service that most patients would choose over the ED if more were available.