• Federico Lega and Alessandro Mengoni.
• Bocconi University, Milano, Italy. federico.lega@unibocconi.it
• Health Policy. 2008 Dec 1;88(2-3):326-38.

ObjectiveTo investigate structural and psychological factors that lead non-urgent patients to choose the Accidents & Emergency Department (A&ED) rather than primary care services.Data SourcesData were collected through interviews by means of a structured questionnaire. Data regarding the A&ED sample were also drawn from the database of the department.Study DesignHypotheses were tested in a survey comparing A&ED non-urgent patients and patients using GP surgeries. Different perceptions of the characteristics of A&ED and primary care services were measured and a perceptual map was created using the linear discriminant analysis (LDA).Data CollectionEmergency services users were interviewed in the A&ED of the General Hospital of the Province of Macerata (Italy). Primary care users were interviewed in four GP surgeries. 527 patients were interviewed between December 2006 and February 2007.Principal FindingsA&ED and primary care patients look for different characteristics as diagnostic and therapeutic potentialities, empathy and competence, quick access or long-lasting relationship. Information asymmetry explains part of the behaviour.ConclusionsUse of A&ED services for non-urgent care can be reduced. The understanding of reasons underlying the choice and a change in access, timing and contents of care/services provided by general practitioners (GPs) might provide incentives for shifting from A&ED to GPs surgeries.

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