Keywords: Emergency department, Primary care, Non-urgent, Patient satisfaction

Background:

Non-urgent emergency department (ED) visits during weekday working hours place unnecessary strain on healthcare systems. Although patient satisfaction is a core component of service quality, its role in influencing care-seeking behavior between primary care (PC) and ED services remains unclear.

Research questions:

1-Does patient satisfaction mediate the relationship between primary care utilization and non-urgent ED use?
2- What patterns link frequency of visits and satisfaction levels with either service?

Method:

This observational study compared patient satisfaction levels using two validated tools: the EUROPEP (European Patients Evaluate General/Family Practice) scale for PC visits, and the Brief Emergency Department Patient Satisfaction Scale (BEPSS) for ED visits. Data analysis was conducted using Jamovi software (version 2.6.26), employing structural equation modeling and correlation analysis.

Results:

A total of 293 patients participated in the study (61.4% female). Examination-only visits accounted for 43.7% of PC and 66.6% of ED encounters. Satisfaction rate was higher in ED (75.0%) compared to PC (66.7%). Frequent users of non-urgent ED services were also more likely to utilize PC services (r = 0.394, p ≤ 0.001). A positive correlation was observed between satisfaction with previous PC and ED experiences (r = 0.399, p ≤ 0.001). However, higher satisfaction with either service was not associated with increased visit frequency (p > 0.05). Notably, frequency of PC visits mediated the relationship between older age and increased non-urgent ED use (β = 0.067, 95% CI [0.002, 0.029], p = 0.028), suggesting insufficient referrals from PC to ED.

Conclusions:

Higher satisfaction with PC or ED does not predict increased utilization. Frequent non-urgent ED use among older adults may reflect inadequate coordination or referral between services rather than dissatisfaction. In addition, improving satisfaction alone is insufficient without addressing overuse, maladaptive health-seeking behavior, and the need for a referral system or standardized family health center enhanced resources.

Points for discussion:

– How can PC systems be restructured to reduce avoidable ED visits?

– Should referral mechanisms be mandated to guide non-urgent patient flow?