Official websites use. Share sensitive information only on official, secure websites. Inappropriate use is a burden on healthcare costs and increases the risk of ED overcrowding. The aim of this study was to explore socioeconomic and geographical determinants of inappropriate ED use in France.
The French Emergency Survey was a nationwide cross-sectional survey conducted on June 11 , simultaneously in all EDs in France and covered characteristics of patients, EDs and counties. The appropriateness of the ED visit was assessed by three measures: caring physician appreciation of appropriateness numeric scale , caring physician appreciation of whether or not the patient could have been managed by a general practitioner and ED resource utilisation. Not having a private supplementary health insurance, having universal supplementary health coverage and symptoms being several days old increased the likelihood of inappropriate use.
Likelihood of inappropriate use was not associated with county medical density. Inappropriate ED use appeared associated with socioeconomic vulnerability such as not having supplementary health coverage or having universal coverage but not with geographical characteristics. It makes us question the appropriateness of the concept of inappropriate ED use as it does not consider the distress experienced by the patient, and segments of society seem to have few other choices to access healthcare than the ED.
Keywords: emergency department, primary care, healthcare quality improvement, health services research. Several studies have underlined significant inequities in primary healthcare in selected Organisation for Economic Co-operation and Development countries. Across Europe, different models of out-of-hours primary care exist 6 7 and ED use must be considered among other unscheduled care options. Unscheduled care in France includes EDs but also general practitioners GPs performing home visits during the day time and out-of-hours or GPs with extended opening hours.
Several studies have described that the distress experienced by the patient defined as the lived experience and anxiety of the person seeking help in an ED might contrast with the discharge diagnosis. Recent studies have reported on substantial social disparities in health 29β31 and healthcare access 1 32 worldwide. From the patient perspective, the choice to self-refer to an ED rather than an GP depends on both individual characteristics such as socioeconomics and health insurance coverage and contextual factors, with the availability of primary care services possibly being one of the most important.
