Does cost drive primary care patients to New Zealand's emergency departments? A systematic review.

Aim: The cost of primary care is often stated as a major contributing factor to presentations to New Zealand Emergency Departments. This review sought to determine whether this assumption is supported by the literature.

Methods: A structured search in Medline, hand search of the New Zealand Medical Journal and citation searching was conducted for articles exploring the reasons for presentation to New Zealand Emergency Departments. Articles were screened for relevance and potentially relevant articles, including those in the Grey literature were retrieved for full text review. Included studies were reviewed independently by the authors and data was extracted using a standardised template. Differences were resolved by consensus.

Results: There were 485 articles identified, of which 11 were relevant and included. A total of 8463 patients with minor illness or injury were interviewed. Of 5850 patients who were asked a direct question about cost, only 119 patients cited this as a reason for coming to ED (2%, 95%CI 1.7-2.4%). The most common reason for presentation was a belief that the Emergency Department was the most appropriate place to be seen for that problem.

Conclusion: The cost of primary care is a factor in Emergency Department presentation for only a small minority of patients.