Frequent users of emergency departments. Do they also use family physicians' services?

OBJECTIVE To determine whether frequent users of emergency department (ED) services use more or fewer primary care services than other ED patients.

DESIGN Population-based, observational, cross-sectional study.

SETTING Province of Ontario in 1997-1998.

PARTICIPANTS Frequent users of EDs, defined as people with at least 12 ED physician assessments yearly, were compared with those with one to 11 assessments yearly.

MAIN OUTCOME MEASURES Number of general practitioner and family physician (GP/FP) office visits and number of GP/FPs visited; diagnoses made during office visits; referrals by GP/FPs to specialists.

RESULTS Three quarters of frequent users of EDs visited GP/FPs at least six times yearly, and more than half visited at least 12 times yearly. Although frequent users of EDs saw many GP/FPs (4.2 vs 1.6 in the control group, P < .001), they received, on average, 73% of their primary care from the GP/FPs whom they saw most frequently. Frequent users of EDs also had more referrals to specialists (4.0 vs 1.0). Frequent users of EDs were more likely to live in low socioeconomic neighbourhoods and to be diagnosed with psychosocial conditions (24.1% vs 11.1%).

CONCLUSION Most frequent users of EDs have periodic contact with primary care physicians. Communication and coordination of care between EDs and primary care settings could be easier than anticipated, because in most cases, frequent users of EDs seek most of their care from one main ED and one primary care physician.