Why patients attend emergency department for primary care type problems: views of healthcare providers working in a remote community

Introduction: Emergency Department (ED) utilisation continues to increase, particularly for primary care presentations that do not require high level ED services.  The reasons for this are complex and research has focused on patient perspectives in choosing where to seek care rather than those of ED and general practice (GP) providers. This study aimed to address this gap by exploring the views of Emergency Department (ED) and General Practice (GP) providers regarding ED utilisation for primary care type health conditions in a small, remote city with perhaps unique population demographics and service configuration.  
Methods: Service providers from the ED and GP clinics were invited to participate in focus groups and semi-structured interviews exploring their views on ED utilisation for primary care type health conditions. The data were analysed using thematic content analysis.
Results: 24 healthcare providers (five GPs, seven ED practitioners, seven nurse navigators, four Aboriginal and Torres Strait Islander Health Workers and one Indigenous Liaison Officer) participated in focus groups discussion and interviews. The analysis identified three themes: access and logistic barriers, rational decision-making, and self-perceived urgency.  While there was some overlap in the healthcare providers' perceptions, there were also strong differences between ED and GP groups. In particular, the ED group believed that GP services are less accessible for urgent appointments, whereas GPs believed that such arrangements were in place. Both groups agreed on the need for clear communication between the ED and GP.  
Conclusion: ED and GP providers demonstrate similarities and differences in understanding patients reasons for choosing which service to access. The differences may stem from ED providers’ focus on offering a rapid resolution of acute presentations and GP providers’ focus on offering comprehensive and continuing care. Effective communication between GP and the ED services and clearer referral pathways may help in reducing ED utilisation for less urgent primary care type problems.