The Role of System-Level Primary Care Characteristics and Immigration Status as Predictors of Non-Urgent Emergency Department Presentations
Non-urgent health conditions are best served in primary care settings (e.g. family practices and walk-in clinics). Despite this, patients commonly present to emergency departments (EDs) for non-urgent conditions, especially with upper respiratory tract infections (URTIs). This leads to poor patient health outcomes and greater healthcare system costs. Immigrants also use EDs non-urgently at a greater rate than non-immigrants. To further our understanding of factors associated with non-urgent ED use, a systematic review on system-level primary care provider (PCP) characteristics associated with non-urgent ED presentations and a study on the association between new immigrant status and non-urgent URTI ED presentations were conducted. Two studies were conducted: a systematic review of quantitative studies published between January 1, 2000, and February 12, 2025, on the associations between system-level PCP characteristics and non-urgent ED presentations; and a population-based cohort study (n=13,232,410) on the associations between immigration status and immigrant-related characteristics with non-urgent URTI ED presentations in Ontario. A total of 37 quantitative studies were identified between January 1, 2000 and February 12, 2025 that focused on the association between system-level PCP characteristics and non-urgent ED presentations globally (i.e., Canada=10, USA=10, Europe=10, Asia/Oceania=6, South America=1). Across these studies, four categories of PCP characteristics were revealed: decreased PCP availability, greater distance to PCPs, poor quality of care, and varying PCP care/payment models. In the cohort study, new immigrants to Ontario were 14% (relative risk [RR]=0.86, 95% confidence interval [CI] 0.82-0.90) less likely to make non-urgent URTI ED presentations versus non-immigrants. Immigrants whose mother tongue was Punjabi or who originated from India or the Philippines were less likely to make non-urgent URTI ED presentations. Conversely, Francophone and non-English/French-speaking immigrants, refugees, and those with capitated PCPs were more likely to make non-urgent URTI ED presentations. Increasing PCP availability, PCP proximity to patients, improving the quality of PCP care, and using patient enrolment and team-based models could offset non-urgent ED presentations. Decreased non-urgent URTI ED presentations by immigrants may demonstrate the healthy immigrant effect or learned healthcare-seeking behaviour. Francophone and non-official language-speaking immigrants, refugees, and patients of capitated PCPs may benefit from greater PCP access.
INTERDISCIPLINARY RESEARCH AREAS::Health and medical services in society, MEDICINE::Social medicine::Public health medicine research areas::Family medicine, MEDICINE::Social medicine::Public health medicine research areas::Epidemiology, MEDICINE::Social medicine::Public health medicine research areas::Public health science, MEDICINE::Social medicine::Public health medicine research areas::Community medicine
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