ArticleBMJ open2017
Why do patients seek primary medical care in emergency departments? An ethnographic exploration of access to general practice.
Article in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
55 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Impact of the clinically oriented roles of a general practice receptionist: a systematic review with narrative synthesis.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Pooled it
- Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare - systematic review.BMC health services research · 2020Pooled it
- Barriers to and facilitators of the implementation of multi-disciplinary care pathways in primary care: a systematic review.BMC family practice · 2020Pooled it
- Beyond forest plots: clinical gestalt and its influence on COPD telemonitoring studies and outcomes review.BMJ open · 2019Pooled it
- Caring for older adults in the Emergency Department: a Delphi-based national consensus by the Academy of Emergency Medicine and Care and the Italian Society of Gerontology and Geriatrics.European geriatric medicine · 2026Article
- A scoping review of how the candidacy framework has been used in research on access to general practice.Journal of health services research & policy · 2026Article
- Determining the Impact of a Physiotherapist-Led Primary Care Model for Hip and Knee Pain: Protocol and Analysis Plan for a Cluster Randomized Controlled Trial With Process Evaluation.JMIR research protocols · 2026Article
- Remote Access to Primary Care: Theorising 'Care Navigation'.Sociology of health & illness · 2026Article
- What do patients and clinicians think about continuity in general practice in England? a qualitative study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2026Article
- Why do patients attend out-of-hours GP services in Ireland?Irish journal of medical science · 2025Article
- Could low-acuity emergency medical services patients be redirected to primary care? Findings from a multi-center survey in Berlin, Germany.BMC emergency medicine · 2025Observational
- Advanced Access in Primary Healthcare and Its Effects on Emergency Department Utilization: A Rapid Review.Healthcare (Basel, Switzerland) · 2025Review
- Clinical decision instruments for predicting mortality in patients with cirrhosis seeking emergency department care.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2025Article
- Attendance at remote versus in-person outpatient appointments in an NHS Trust.Journal of telemedicine and telecare · 2025Observational
- Article
- Leveraging LLM to identify missed information in patient-physician communication: improving healthcare service quality.Frontiers in medicine · 2025Article
- Observational
- Understanding access to general practice through the lens of candidacy: a critical review of the literature.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024Review
- Health care utilization of patients with acute abdominal pain before and after emergency department visits.Scandinavian journal of trauma, resuscitation and emergency medicine · 2024Article
- Factors affecting the experience of joined-up, continuous primary care in the absence of relational continuity: an observational study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors.
Funding
Abstract
objectivesTo describe how processes of primary care access influence decisions to seek help at the emergency department (ED).
designEthnographic case study combining non-participant observation, informal and formal interviewing.
settingSix general practitioner (GP) practices located in three commissioning organisations in England. PARTICIPANTS AND
methodsReception areas at each practice were observed over the course of a working week (73 hours in total). Practice documents were collected and clinical and non-clinical staff were interviewed (n=19). Patients with recent ED use, or a carer if aged 16 and under, were interviewed (n=29).
resultsPast experience of accessing GP care recursively informed patient decisions about where to seek urgent care, and difficulties with access were implicit in patient accounts of ED use. GP practices had complicated, changeable systems for appointments. This made navigating appointment booking difficult for patients and reception staff, and engendered a mistrust of the system. Increasingly, the telephone was the instrument of demand management, but there were unintended consequences for access. Some patient groups, such as those with English as an additional language, were particularly disadvantaged, and the varying patient and staff semantic of words like 'urgent' and 'emergency' was exacerbated during telephone interactions. Poor integration between in-hours and out-of-hours care and patient perceptions of the quality of care accessible at their GP practice also informed ED use.
conclusionsThis study provides important insight into the implicit role of primary care access on the use of ED. Discourses around 'inappropriate' patient demand neglect to recognise that decisions about where to seek urgent care are based on experiential knowledge. Simply speeding up access to primary care or increasing its volume is unlikely to alleviate rising ED use. Systems for accessing care need to be transparent, perceptibly fair and appropriate to the needs of diverse patient groups.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.