Reasons for attending a general emergency outpatient clinic versus a regular general practitioner – a survey among immigrant and native walk-in patients in Oslo, Norway

Objective: To explore reasons for attending a general emergency outpatient clinic versus a regular general practitioner (RGP). Design: Cross-sectional study using a multilingual anonymous questionnaire. Setting: Native and immigrant walk-in patients attending a general emergency outpatient clinic in Oslo (Monday–Friday, 08:00–23:00) during 2 weeks in September 2009. Subjects: We included 1022 walk-in patients: 565 native Norwegians (55%) and 457 immigrants (45%). Main outcome measures: Patients’ reasons for attending an emergency outpatient clinic versus their RGP. Results: Among patients reporting an RGP affiliation, 49% tried to contact their RGP before this emergency encounter: 44% of native Norwegian and 58% of immigrant respondents. Immigrants from Africa [odds ratio (OR) = 2.55 (95% confidence interval [CI]: 1.46–4.46)] and Asia [OR = 2.32 (95% CI: 1.42–3.78)] were more likely to contact their RGP before attending the general emergency outpatient clinic compared with native Norwegians. The most frequent reason for attending the emergency clinic was difficulty making an immediate appointment with their RGP. A frequent reason for not contacting an RGP was lack of access: 21% of the native Norwegians versus 4% of the immigrants claimed their RGP was in another district/municipality, and 31% of the immigrants reported a lack of affiliation with the RGP scheme. Conclusions and implications: Access to primary care provided by an RGP affects patients’ use of emergency health care services. To facilitate continuity of health care, policymakers should emphasize initiatives to improve access to primary health care services.KEY POINTSAccess to immediate primary health care provided by a regular general practitioner (RGP) can reduce patients’ use of emergency health care services.The main reason for attending a general emergency outpatient clinic was difficulty obtaining an immediate appointment with an RGP.A frequent reason for native Norwegians attending a general emergency outpatient clinic during the daytime is having an RGP outside Oslo.Lack of affiliation with the RGP scheme is a frequent reason for attending a general emergency outpatient clinic among immigrants. Access to immediate primary health care provided by a regular general practitioner (RGP) can reduce patients’ use of emergency health care services. The main reason for attending a general emergency outpatient clinic was difficulty obtaining an immediate appointment with an RGP. A frequent reason for native Norwegians attending a general emergency outpatient clinic during the daytime is having an RGP outside Oslo. Lack of affiliation with the RGP scheme is a frequent reason for attending a general emergency outpatient clinic among immigrants.

研究目标：探讨患者选择前往全科急诊门诊（general emergency outpatient clinic）而非普通全科医师（regular general practitioner, RGP）就诊的原因。
研究设计：采用多语言匿名问卷开展的横断面研究。
研究场景：2009年9月为期2周内，挪威奥斯陆某全科急诊门诊（周一至周五，08:00-23:00）的本土及移民随到随诊患者。
研究对象：共纳入1022名随到随诊患者，其中565名为挪威本土居民（占比55%），457名为移民患者（占比45%）。
主要结局指标：患者选择前往急诊门诊而非普通全科医师就诊的原因。
研究结果：在报告拥有普通全科医师签约关系的患者中，49%在本次急诊就诊前尝试联系过其签约全科医师：其中挪威本土居民占44%，移民患者占58%。与挪威本土居民相比，来自非洲[比值比（odds ratio, OR）=2.55，95%置信区间（95% confidence interval, CI）：1.46~4.46]及亚洲[OR=2.32，95%CI：1.42~3.78]的移民患者在前往全科急诊门诊前更倾向于联系其签约全科医师。患者选择急诊门诊的最常见原因为无法立即预约到其签约全科医师的号源。未联系签约全科医师的常见原因为就诊可及性不足：21%的挪威本土居民称其签约全科医师位于其他区县/市政辖区，仅4%的移民患者存在此类情况；另有31%的移民患者表示未签约全科医师诊疗服务体系。
结论与启示：普通全科医师提供的初级卫生保健服务可及性会影响患者对急诊医疗服务的使用。为促进医疗服务连续性，政策制定者应出台相关举措以改善初级卫生保健服务的可及性。
核心要点：
1. 可及时获取普通全科医师提供的初级卫生保健服务，可减少患者对急诊医疗服务的使用；
2. 患者选择前往全科急诊门诊的最主要原因为无法立即预约到签约全科医师的号源；
3. 日间前往全科急诊门诊的挪威本土居民，常见原因为其签约全科医师位于奥斯陆以外地区；
4. 未签约全科医师诊疗服务体系是移民患者选择前往全科急诊门诊的常见原因。