Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Research

Factors predicting patient use of the emergency department: a retrospective cohort study

Jane McCusker, Pierre Tousignant, Roxane Borgès Da Silva, Antonio Ciampi, Jean-Frédéric Lévesque, Alain Vadeboncoeur and Steven Sanche
CMAJ April 03, 2012 184 (6) E307-E316; DOI: https://doi.org/10.1503/cmaj.111069
Jane McCusker
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and St. Mary’s Research Centre, (McCusker, Ciampi); the Institut national de santé publique du Québec, and Department of Epidemiology, Biostatistics and Occupational Health (Tousignant), McGill University; the Department of Epidemiology, Biostatistics and Occupational Health, (Borgès Da Silva) McGill University; the Centre de recherche du Centre hospitalier de l’Université de Montréal et Institut national de santé publique du Québec (Lévesque); the Department of Emergency Medicine Services (Vadeboncoeur), Montreal Institute of Cardiology; and St. Mary’s Research Centre (Sanche), Montréal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: jane.mccusker@mcgill.ca
Pierre Tousignant
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and St. Mary’s Research Centre, (McCusker, Ciampi); the Institut national de santé publique du Québec, and Department of Epidemiology, Biostatistics and Occupational Health (Tousignant), McGill University; the Department of Epidemiology, Biostatistics and Occupational Health, (Borgès Da Silva) McGill University; the Centre de recherche du Centre hospitalier de l’Université de Montréal et Institut national de santé publique du Québec (Lévesque); the Department of Emergency Medicine Services (Vadeboncoeur), Montreal Institute of Cardiology; and St. Mary’s Research Centre (Sanche), Montréal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Roxane Borgès Da Silva
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and St. Mary’s Research Centre, (McCusker, Ciampi); the Institut national de santé publique du Québec, and Department of Epidemiology, Biostatistics and Occupational Health (Tousignant), McGill University; the Department of Epidemiology, Biostatistics and Occupational Health, (Borgès Da Silva) McGill University; the Centre de recherche du Centre hospitalier de l’Université de Montréal et Institut national de santé publique du Québec (Lévesque); the Department of Emergency Medicine Services (Vadeboncoeur), Montreal Institute of Cardiology; and St. Mary’s Research Centre (Sanche), Montréal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Antonio Ciampi
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and St. Mary’s Research Centre, (McCusker, Ciampi); the Institut national de santé publique du Québec, and Department of Epidemiology, Biostatistics and Occupational Health (Tousignant), McGill University; the Department of Epidemiology, Biostatistics and Occupational Health, (Borgès Da Silva) McGill University; the Centre de recherche du Centre hospitalier de l’Université de Montréal et Institut national de santé publique du Québec (Lévesque); the Department of Emergency Medicine Services (Vadeboncoeur), Montreal Institute of Cardiology; and St. Mary’s Research Centre (Sanche), Montréal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jean-Frédéric Lévesque
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and St. Mary’s Research Centre, (McCusker, Ciampi); the Institut national de santé publique du Québec, and Department of Epidemiology, Biostatistics and Occupational Health (Tousignant), McGill University; the Department of Epidemiology, Biostatistics and Occupational Health, (Borgès Da Silva) McGill University; the Centre de recherche du Centre hospitalier de l’Université de Montréal et Institut national de santé publique du Québec (Lévesque); the Department of Emergency Medicine Services (Vadeboncoeur), Montreal Institute of Cardiology; and St. Mary’s Research Centre (Sanche), Montréal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Alain Vadeboncoeur
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and St. Mary’s Research Centre, (McCusker, Ciampi); the Institut national de santé publique du Québec, and Department of Epidemiology, Biostatistics and Occupational Health (Tousignant), McGill University; the Department of Epidemiology, Biostatistics and Occupational Health, (Borgès Da Silva) McGill University; the Centre de recherche du Centre hospitalier de l’Université de Montréal et Institut national de santé publique du Québec (Lévesque); the Department of Emergency Medicine Services (Vadeboncoeur), Montreal Institute of Cardiology; and St. Mary’s Research Centre (Sanche), Montréal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Steven Sanche
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and St. Mary’s Research Centre, (McCusker, Ciampi); the Institut national de santé publique du Québec, and Department of Epidemiology, Biostatistics and Occupational Health (Tousignant), McGill University; the Department of Epidemiology, Biostatistics and Occupational Health, (Borgès Da Silva) McGill University; the Centre de recherche du Centre hospitalier de l’Université de Montréal et Institut national de santé publique du Québec (Lévesque); the Department of Emergency Medicine Services (Vadeboncoeur), Montreal Institute of Cardiology; and St. Mary’s Research Centre (Sanche), Montréal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading

Article Figures & Tables

Figures

  • Tables
  • Figure 1:
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 1:

    Incidence rate ratios for use of the emergency department by affiliation with a primary physician (overall and stratified by age) among 311 701 patients who made three or more physician visits during the baseline period. Models adjusted for age, sex, material deprivation, area of residence, number of physician visits and time spent in hospital during baseline. Patients with a specialist or no primary physician are compared, with patients with a family physician acting as the reference group. CI = confidence interval, IRR = incidence rate ratio.

  • Figure 2:
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 2:

    Incidence rate ratios for use of the emergency department by continuity of care by a family physician (overall and stratified by number of doctor visits) among 271 990 patients who made three or more visits to physicians during the baseline period, and who have a family physician. Models adjusted for age, sex, material depreivation, area of residence, number of physician visits and time spent in hospital during baseline. Patient with low or medium scores on the Usual Provider Care index are compared, with high scores acting as the reference group. CI = confidence interval, IRR = incidence rate ratios, UPC = usual provider continuity.

  • Figure 3:
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 3:

    Incidence rate ratios for use of the emergency department by continuity of care by a specialist (overall and stratified by comorbidity score and number of days spent in hospital) among 27 752 patients who made three or more visits to physicians during the baseline period and who have a specialist as their primary physician. Models adjusted for age, sex, material deprivation, area of residence, number of physician visits and time spent in hospital during baseline. Patients with low or medium scores on the Usual Provider Care index are compared, with patients with high scores acting as the reference group. CI = confidence interval, IRR = incidence rate ratio, UPC = usual provider continuity.

Tables

  • Figures
    • View popup
    Table 1:

    Characteristics of the excluded sample (i.e., low users) and the analysis cohort during the two-year baseline and one-year follow-up periods

    CharacteristicPatients with fewer than 3 visits to a physician during baseline, %
    n = 55 614
    Analysis cohort
    Total, %
    n = 311 701
    No primary physician, %
    n= 11 959
    Family physician, %
    n = 271 990
    Specialist, %
    n = 27 752
    Age, yr
    18–3440.924.846.322.334.1
    35–6454.256.847.558.051.8
    65–743.111.13.911.98.7
    ≥ 751.87.32.47.85.5
    Sex
    Male63.841.854.740.446.2
    Female36.258.245.359.653.8
    Material deprivation percentile
    1–5053.155.057.054.756.4
    51–10044.943.041.143.341.5
    Missing2.02.11.92.12.1
    Area of residence
    Urban44.738.831.140.331.1
    Metropolitan55.361.268.959.768.9
    Health status, comorbidity score percentile
    Low, 0–6076.056.559.955.463.8
    Medium, 61–8021.524.430.923.924.8
    High, 81–1002.619.19.220.711.4
    Visits to physicians during baseline, no.
    0–2100.0————
    3–8—48.091.743.164.9
    9–24—43.07.546.930.6
    ≥ 25—9.00.810.14.6
    Time spent in hospital during baseline, d
    097.485.993.386.379.0
    1–31.14.52.54.27.6
    ≥ 41.59.64.39.513.4
    Visits to emergency department during baseline, no.
    070.161.763.661.760.6
    120.020.120.520.120.6
    25.88.78.78.69.1
    ≥ 34.19.57.39.69.8
    Affiliation with a primary physician
    Low user100.0————
    None—5.5100.0——
    Family physician—84.1—100.0—
    Specialist—10.3——100.0
    Usual provider continuity index with a primary physician*
    Low (< 0.40)—32.5—34.715.2
    Medium (0.40–0.79)—51.1—49.564.1
    High (0.80–1.0)—16.4—15.820.7
    Complete annual examinations, no.
    0—65.8—59.3—
    1—25.0—29.8—
    ≥ 2—9.2—11.0—
    Visits to emergency department during follow-up, no.
    082.576.278.075.977.4
    112.115.014.315.114.4
    23.44.94.75.04.6
    ≥ 31.93.93.04.03.6
    • ↵* Among participants with a primary physician (n = 299 742).

    • View popup
    Table 2:

    Primary care variables predicting use of emergency department, overall and by patient baseline characteristics*

    InteractionIRR (95% CI)
    Overall
    Affiliation with a primary physician
     None v. family physician1.12 (1.07–1.17)
     None v. specialist1.08 (1.03–1.14)
     Specialist v. family physician1.03 (1.00–1.06)
    Continuity of care with a family physician†
     Low v. high1.00 (0.97–1.03)
     Medium v. high1.00 (0.97–1.02)
    Complete annual examinations with a family physician, no.
     0 v. 21.23 (1.19–1.27)
     1 v. 21.10 (1.07–1.14)
    Continuity of care with a specialist†
     Low v. high1.17 (1.07–1.28)
     Medium v. high1.10 (1.01–1.18)
    Age, 18–64 yr
    Affiliation with a primary physician
     None v. family physician1.11 (1.05–1.16)
     None v. specialist1.10 (1.04–1.17)
     Specialist v. family physician1.00 (0.97–1.04)
    Age, ≥ 65 yr
    Affiliation with a primary physician
     None v. family physician1.26 (1.18–1.34)
     None v. specialist1.11 (1.04–1.19)
     Specialist v. family physician1.13 (1.09–1.17)
    Visits to physicians during baseline, 3–24
    Continuity of care with a family physician†
     Low v. high0.98 (0.95–1.01)
     Medium v. high0.99 (0.96–1.02)
    Visits to physicians during baseline, ≥ 25
    Continuity of care with a family physician†
     Low v. high1.17 (1.07–1.28)
     Medium v. high1.13 (1.04–1.24)
    No or low comorbidity score‡
    Continuity of care with a specialist†
     Low v. high1.10 (0.96–1.27)
     Medium v. high1.10 (1.00–1.22)
    Medium comorbidity score‡
    Continuity of care with a specialist†
     Low v. high1.48 (1.22–1.79)
     Medium v. high1.28 (1.08–1.51)
    High comorbidity score‡
    Continuity of care with a specialist†
     Low v. high0.98 (0.80–1.21)
     Medium v. high0.93 (0.77–1.13)
    Time spent in hospital, 0 d
    Continuity of care with a specialist†
     Low v. high1.11 (0.99–1.25)
     Medium v. high1.08 (0.98–1.18)
    Time spent in hospital, 1–3 d
    Continuity of care with a specialist†
     Low v. high1.75 (1.33–2.30)
     Medium v. high1.31 (1.05–1.65)
    Time spent in hospital, ≥ 4 d
    Continuity of care with a specialist†
     Low v. high1.11 (0.90–1.37)
     Medium v. high1.05 (0.87–1.27)
    • Note: CI = confidence interval, IRR = incidence rate ratio.

    • ↵* Selection of interactions based on statistical significance (p < 0.05) and clinical importance (15% difference in IRR).

    • ↵† Based on score on usual provider continuity index.

    • ↵‡ See Appendix 2 for derivation of comorbidity scores.

PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 184 (6)
CMAJ
Vol. 184, Issue 6
3 Apr 2012
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Factors predicting patient use of the emergency department: a retrospective cohort study
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Factors predicting patient use of the emergency department: a retrospective cohort study
Jane McCusker, Pierre Tousignant, Roxane Borgès Da Silva, Antonio Ciampi, Jean-Frédéric Lévesque, Alain Vadeboncoeur, Steven Sanche
CMAJ Apr 2012, 184 (6) E307-E316; DOI: 10.1503/cmaj.111069

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Factors predicting patient use of the emergency department: a retrospective cohort study
Jane McCusker, Pierre Tousignant, Roxane Borgès Da Silva, Antonio Ciampi, Jean-Frédéric Lévesque, Alain Vadeboncoeur, Steven Sanche
CMAJ Apr 2012, 184 (6) E307-E316; DOI: 10.1503/cmaj.111069
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Abstract
    • Methods
    • Results
    • Interpretation
    • Footnotes
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • Highlights
  • PubMed
  • Google Scholar

Cited By...

  • Improving access to primary healthcare for vulnerable populations in Australia and Canada: protocol for a mixed-method evaluation of six complex interventions
  • Combined impacts of multimorbidity and mental disorders on frequent emergency department visits: a retrospective cohort study in Quebec, Canada
  • Geographic clustering of emergency department presentations for acute coronary syndromes and heart failure in Alberta: a population-based study
  • Early Follow-Up After a Heart Failure Exacerbation: The Importance of Continuity
  • Validation of 2 New Measures of Continuity of Care Based on Year-to-Year Follow-up With Known Providers of Health Care
  • Physician Continuity Improves Outcomes for Heart Failure Patients Treated and Released From the Emergency Department
  • Which features of primary care affect unscheduled secondary care use? A systematic review
  • Impact of physician continuity on death or urgent readmission after discharge among patients with heart failure
  • Google Scholar

More in this TOC Section

  • Statin initiation and risk of incident kidney disease in patients with diabetes
  • Acute care related to cannabis use during pregnancy after the legalization of nonmedical cannabis in Ontario
  • Safer opioid supply via a biometric dispensing machine: a qualitative study of barriers, facilitators and associated outcomes
Show more Research

Similar Articles

Collections

  • Topics
    • Medical careers
    • Patient education

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

CMA Civility, Accessibility, Privacy

 

Powered by HighWire