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KCE reports vol. 19B Urgences 101
AUTHOR, YEAR
COUNTRY
DRUMMOND ET AL,
2000
UK
FRANCO SM ET AL, 1997
USA
GORDON JA, 2001
USA
STUDY DESIGN
SAMPLE
SETTING
Cross-sectional 1 week period
Prospective study
Program evaluation
random 1:2 sample
postal questionnaire
sociodemografic data extracted from the service
contact sheet
Glasgow EMS
Review of medical records
Urban indigent pediatric population
Cross-sectional over 24 hours consecutive patients (incl.
ambulance)
fall of 1997
3EDs (urban public teaching hospital, a suburban
university hospital, and a semirural community
hospital)
RESULT / CONCLUSION
Two factors characterised as 'perceived problems with daytime services' and 'perceived urgency'
were identified.
scores were higher in adults, in males, among the non-affluent (particularly those resident in
deprived areas), and in those presenting with a musculoskeletal problem. Scores on the latter
dimension were significantly associated with age and presenting problem.
Compared to those from affluent areas, patients from non-affluent areas appear to perceive
difficulties accessing their general practitioner during surgery hours and may contact out-of-hours
services as an alternative
Parental experience, i.e. age and number of children, play a significant role in ED use
KenPAC: 24-hour access to primary care physician + ED gatekeeping
Ed visits declined (10% to 7.6%)
Inappropriate visits dropped (41% to 8%)
Thus gatekeeping activity contribute to reduce overall and inappropriate use of th ED
Index of socioeconomic deprivation described by the US Census Bureau (based on food, housing,
and utilities)
Many ED patients suffer from fundamental social deprivations that threaten basic health. The most
disadvantaged of these patients frequently lack contact with other medical care sites or public
assistance networks.