Impact of the primary health care reform on the use of the hospital emergency areas

BACKGROUND: The overutilization of the hospital emergency areas (HEA) in recent years has been related to an inadequate functioning of the primary health care and can be corrected by the implementation of the primary health care reform. MATERIAL AND METHODS: Home interview of a sample of residents of the city of Mataro (Barcelona, Spain), where the primary health care reform affects to four of the seven basic health areas. Collection of information on health care utilization and attitudes to its use. RESULTS: Of the 1,974 studied subjects 27% (CI 95%, 25-29) reported to have used the HEA in the former year, and the frequency of visits was 0.48 (CI 95%, 0.44-0.54) per person. For the 1880 beneficiaries of the national health system, these results were somewhat lower between the users of reformed centres (27%, 0.46) than those of non-reformed centres (30%, 0.50) (p = NS); differences were attributed mainly to adult women. Users of reformed centres expressed more preference for the ambulatory in case of a non-severe emergency (37% and 17%; p < 0.0001) and consulted more often before going to the HEA (17 acid 10%; p = 0.03), Among the reasons to go to the HEA, users of the reformed model perceived less necessity of an immediate action (43 and 52%; p = 0.05) and greater time barriers with the basic health areas (23 and 15%; p = 0.04). CONCLUSIONS: In spite of the lack of overall differences in the use of HEA between users of reformed centres and non-reformed centres we observed a lower utilization in some age and sex groups from reformed centres. Some elements of the demand of the HEA are more appropriate and attributed to the primary health care reform. However, the reasons prompting to use the HEA show that an unjustified utilization is still done, independently of the primary health care model.