Does better access to FPs decrease the likelihood of emergency department use? Results from the Primary Care Access Survey.

OBJECTIVE: To determine whether better access to FP services decreases the likelihood of emergency department (ED) use among the Ontario population.

DESIGN: Population-based telephone survey.

SETTING: Ontario.

PARTICIPANTS: A total of 8502 Ontario residents aged 16 years and older.

MAIN OUTCOME MEASURES: Emergency department use in the 12 months before the survey.

RESULTS: Among the general population, having a regular FP was associated with having better access to FPs for immediate care (P < .001) but was not associated with a decreased likelihood of ED visits (odds ratio [OR] = 1.49, P = .03). Better actual access to FP services for immediate care was associated with a decreased likelihood of ED use (OR = 0.62, P < .001) among the general population. Among those with chronic diseases, having a regular FP was associated with a decreased likelihood of ED use (OR = 0.47, P = .01). Of the Ontario population, 39.3% wanted to see FPs for immediate care at least once a year; 63.1% of them had seen FPs without difficulties and were significantly less likely to use EDs than those who did not see FPs or had difficulties accessing physicians when needed (OR = 0.62, P < .001). Having a chronic health condition, recent immigrant status, residence in rural and northern parts of Ontario, and lower educational and income levels were significant predictors of a higher likelihood of ED use, independent of access to FPs (P < .05).

CONCLUSION: A decreased likelihood of ED use is strongly associated with having a regular FP among those with chronic diseases and with having access to FPs for immediate care among the general population. Further research is needed to understand what accounts for a higher likelihood of ED use among those with regular FPs, new immigrants, residents of northern and rural areas of Ontario, and people with low socioeconomic status when actual access and sociodemographic characteristics have been taken into consideration. More important, this study demonstrates a need of distinguishing between potential and actual access to care, as having a regular FP and having timely and effective access to FP care might mean different things and have different effects on ED use.