Physician assessment of appropriate healthcare level among nonurgent patients.

Objectives: To analyze the appropriateness of healthcare level chosen by nonurgent patients in an emergency department (ED) compared with unscheduled primary care (PC) patients and the factors influencing physician consideration of appropriate care level.

Study Design: Cross-sectional study.

Methods: This study used structured face-to-face interviews with nonurgent patients at an urban ED and with unscheduled PC patients from a defined catchment area, concomitant with a questionnaire to the treating physician.

Results: General practitioners considered to a higher extent than their ED colleagues that patients chose an appropriate level of care. General practitioners were older and had longer clinical experience than physicians at the ED. Patients considered at an appropriate care level were distinguished by their symptom presentation, shorter duration of symptoms, and more regular previous healthcare use. Men with little regular previous healthcare use were more likely to present with symptoms assessed as inappropriate for the ED (P <.001).

Conclusions: Patients with disorders that ED physicians considered inappropriate for the setting had little regular previous healthcare use but were also managed by less experienced physicians compared with patients in PC. General practitioners agreed with the choice of healthcare level among their patients to a large extent. It is important to meet patient demands and concerns in a professional way and to develop organizational ways to manage patient needs that are suitable for the setting.