Hospital emergency departments: Substitutes for primary care? Results of a survey of the population of Montréal and Montérégie

Hospital emergency departments play a central role in the health care system. They have become the main entry point for hospitalised patients and the resource of choice when primary care services are not available. As a result, emergency department utilisation is a good barometer of how the health system is working. However, the dominant portrait of emergency department utilisation has been constructed from administrative or clinical patient data. Less common are studies that document emergency services utilisation based on survey data. Yet, the latter are unique sources of information on morbidity experienced and on utilisation behaviours of the general population.

The data presented in this thematic report are from a survey of the primary care experiences of individuals in Montréal and Montérégie. The survey is part of a larger study whose aim is to better understand the organisation models of primary care services in Québec and their influence on accessibility and continuity of care. The goal of this report is to provide up-to-date information on hospital emergency department utilisation from the population’s perspective. The following questions are examined: How widespread is the use of emergency departments by the population and what are the influencing factors? Why do individuals choose to go to the emergency when they have a health problem?

An analysis of recent care experiences demonstrates that users of emergency departments are responsible consumers. Several elements influence their decision to go to the emergency when a health problem arises. Some of the significant factors include perception of the urgency and of the seriousness of the problem, as well as recommendation from the health professional consulted. It is clear that an individual’s choice to go to the emergency is affected by the perception that access to primary care services is limited. Going to the emergency also seems to be a way of gaining quicker access to specialised services and resources that are perceived as meeting all health care needs.

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