• Jane McCusker, Danièle Roberge, Jean-Frédéric Lévesque, Antonio Ciampi, Alain Vadeboncoeur, Danielle Larouche, and Steven Sanche.
• Department of Clinical Epidemiology and Community Studies, St Mary's Hospital, Montreal, QC, Canada. jane.mccusker@ssss.gouv.qc.ca
• Med Care. 2010 Nov 1;48(11):972-80.

BackgroundAn emergency department (ED) visit may be a marker for limited access to primary medical care, particularly among those with ambulatory care sensitive chronic conditions (ACSCC).ObjectivesIn a population with universal health insurance, to examine the relationships between primary care characteristics and location of last general physician (GP) contact (in an ED vs. elsewhere) among those with and without an ACSCC.Research DesignA cross-sectional survey using data from 2 cycles of the Canadian Community Health Survey carried out in 2003 and 2005.SubjectsThe study sample comprised Québec residents aged ≥18 who reported at least one GP contact during the previous 12 months, and were not hospitalized (n = 33,491).MeasuresThe primary outcome was place of last GP contact: in an ED versus elsewhere. Independent variables included the following: lack of a regular physician, perceived unmet healthcare needs, perceived availability of health care, number of contacts with doctors and nurses, and diagnosis of an ACSCC (hypertension, heart disease, chronic respiratory disease, diabetes).ResultsUsing multiple logistic regression, with adjustment for sociodemographic, health status, and health services variables, lack of a regular GP and perceptions of unmet needs were associated with last GP contact in an ED; there was no interaction with ACSCC or other chronic conditions.ConclusionsPrimary care characteristics associated with GP contact in an ED rather than another site reflect individual characteristics (affiliation with a primary GP and perceived needs) rather than the geographic availability of healthcare, both among those with and without chronic conditions.

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