Singapore medical journal · 2026
Impact of primary care accessibility and availability on inappropriate emergency department attendance in Singapore.
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Koh Jemima Jia En, Gao Yan, Oh Hong Choon, Goh Priscilla Sook Kheng, Lim Hoon Chin
Аннотация
INTRODUCTION: Primary care providers (PCPs) can safely manage non-emergency acute medical cases, reducing emergency department (ED) visits. This study examined how proximity and availability of PCPs affect inappropriate attendance (IA) at a tertiary hospital ED in eastern Singapore.
METHODS: We conducted a retrospective cohort study of eligible ED visits between 1 January 2023 and 31 December 2023. Reporting followed STROBE guidelines. Multivariable logistic regression assessed the association between IA and (a) travel time to an available PCP, (b) travel distance to an available PCP, and (c) number of available PCPs. An IA was defined by investigations, procedures and discharge type. Models were adjusted for demographics, visit characteristics and prior healthcare utilisation.
RESULTS: In 2023, there were 135,838 eligible ED visits, of which 12.5% were IAs. A travel time of >5 min to a PCP was associated with a 13%-24% higher likelihood of inappropriate ED attendance compared with a travel time of ≤5 min. Similarly, a travel distance of >1 km from a PCP increased the likelihood by 10%-33% compared with a distance of ≤1 km. Conversely, having more than three PCPs within a 1-km radius of the attendee's home was associated with at least a 12% lower likelihood of IA.
CONCLUSION: Longer travel time and distance to a PCP and limited PCP availability were associated with higher risk of IA. Our findings underscore the importance of accessible primary care services, particularly during non-operating hours, in shaping health-seeking behaviour and reducing inappropriate ED visits.
METHODS: We conducted a retrospective cohort study of eligible ED visits between 1 January 2023 and 31 December 2023. Reporting followed STROBE guidelines. Multivariable logistic regression assessed the association between IA and (a) travel time to an available PCP, (b) travel distance to an available PCP, and (c) number of available PCPs. An IA was defined by investigations, procedures and discharge type. Models were adjusted for demographics, visit characteristics and prior healthcare utilisation.
RESULTS: In 2023, there were 135,838 eligible ED visits, of which 12.5% were IAs. A travel time of >5 min to a PCP was associated with a 13%-24% higher likelihood of inappropriate ED attendance compared with a travel time of ≤5 min. Similarly, a travel distance of >1 km from a PCP increased the likelihood by 10%-33% compared with a distance of ≤1 km. Conversely, having more than three PCPs within a 1-km radius of the attendee's home was associated with at least a 12% lower likelihood of IA.
CONCLUSION: Longer travel time and distance to a PCP and limited PCP availability were associated with higher risk of IA. Our findings underscore the importance of accessible primary care services, particularly during non-operating hours, in shaping health-seeking behaviour and reducing inappropriate ED visits.