Morbidity patterns of non-urgent patients attending accident and emergency departments in Hong Kong: cross-sectional study.

OBJECTIVES To study the morbidity patterns of non-urgent patients utilising accident and emergency services and compare these patients with 'true' accident and emergency cases. To analyse the morbidity pattern of non-urgent cases over different time periods, and across different age groups. DESIGN A cross-sectional study completed over a 1-year period. SETTING Four accident and emergency departments in Hong Kong. PATIENTS Two thousand, four hundred and ten patients randomly selected from four accident and emergency departments. MAIN OUTCOME MEASURES The morbidity patterns by body system, according to the International Classification of Primary Care, were tabulated and analysed for 'true' accident and emergency cases versus non-urgent cases. The ten most frequent diagnoses for the 'true' accident and emergency and non-urgent cases were also compared. Further analysis of accident and emergency service utilisation was conducted comparing different age groups, and also different time periods. RESULTS Significantly more cases presenting to the accident and emergency service with respiratory and digestive problems were found to be non-urgent, rather than appropriate accident and emergency cases. In contrast, significantly more cases presenting with circulatory and neurological problems were appropriate cases for accident and emergency department management. The morbidity pattern for the ten most frequent diagnoses seen in non-urgent cases was noted to be similar to the Hong Kong general practice morbidity pattern for self-limiting conditions. Utilisation of accident and emergency services for acute self-limiting conditions was more marked in the late evening, and also among children and the younger population in general. CONCLUSION The utilisation of accident and emergency services by patients requiring a general practice service only, reflects problems in the primary health care delivery system. These may be solved by appropriate interfacing between general practitioners and other service providers, with the aim of providing seamless health care. Without revision of primary health care services, accident and emergency departments will continue to be used inappropriately by patients as an alternative to general practice care.