Sarbay İbrahim, Mercan Baspinar Melike, Erman Ezgi, Cavdar Bilge, Tamer Ilayda, Adiyaman Ayla Muge, Kosali Kafkas, Aksuz Muhammed Yasar, Basat Okcan, Calik Mustafa
Department of Emergency Medicine, University of Health Sciences, Gaziosmanpaşa Training and Research Hospital, Istanbul, Türkiye.
Department of Family Medicine, University of Health Sciences, Gaziosmanpaşa Training and Research Hospital, Istanbul, Türkiye.
J Multidiscip Healthc. 2025 Aug 7;18:4703-4715. doi: 10.2147/JMDH.S532858. eCollection 2025.
To examine whether patient satisfaction mediates the relationship between primary care (PC) utilization and non-urgent emergency department (ED) use during weekday working hours.
This observational study compared patient satisfaction levels using two validated tools: the EUROPEP (European Patients Evaluate General/Family Practice) scale for PC visits and the Brief Emergency Department Patient Satisfaction Scale (BEPSS) for ED visits. Data analysis was conducted using Jamovi software (version 2.6.26), employing structural equation modeling and correlation analysis.
A total of 293 non-urgent adult patients (61.4% female) were enrolled in the study through consecutive sampling at ED visits of a tertiary hospital in Istanbul. Visits solely for examination purposes constituted 43.7% of PC visits and 66.6% of ED visits. Patient satisfaction rates were 66.7% for PC and 75.0% for ED. Frequent users of non-urgent ED services were also more likely to utilize PC services (r = 0.394, p ≤ 0.001). A positive correlation was observed between satisfaction with previous PC and ED experiences (r = 0.399, p ≤ 0.001). However, higher satisfaction with either service was not associated with increased visit frequency (p > 0.05). Notably, frequency of PC visits mediated the relationship between older age and increased non-urgent ED use (β = 0.067, 95% CI [0.002, 0.029], p = 0.028), suggesting insufficient referrals from PC to ED.
Non-urgent ED utilization during working hours is not driven by low PC satisfaction or high ED satisfaction. Improving satisfaction alone is insufficient without addressing overuse, maladaptive health-seeking behavior, and the structural need for standardized medical equipment and adequate human resources in family health centers-rather than relying solely on categorical group classifications.
探讨患者满意度是否介导了工作日工作时间内基层医疗（PC）利用与非紧急急诊科（ED）就诊之间的关系。
这项观察性研究使用两种经过验证的工具比较患者满意度水平：用于基层医疗就诊的EUROPEP（欧洲患者评估综合/家庭医疗）量表和用于急诊科就诊的简短急诊科患者满意度量表（BEPSS）。使用Jamovi软件（版本2.6.26）进行数据分析，采用结构方程建模和相关分析。
通过在伊斯坦布尔一家三级医院的急诊科连续抽样，共招募了293名非紧急成年患者（61.4%为女性）。仅为检查目的的就诊占基层医疗就诊的43.7%，占急诊科就诊的66.6%。基层医疗的患者满意度为66.7%，急诊科为75.0%。非紧急急诊科服务的频繁使用者也更有可能利用基层医疗服务（r = 0.394，p≤0.001）。观察到对先前基层医疗和急诊科经历的满意度之间存在正相关（r = 0.399，p≤0.001）。然而，对任何一种服务的更高满意度与就诊频率增加无关（p>0.05）。值得注意的是，基层医疗就诊频率介导了年龄较大与非紧急急诊科就诊增加之间的关系（β = 0.067，95%CI[0.002，0.029]，p = 0.028），表明从基层医疗到急诊科的转诊不足。
工作时间内非紧急急诊科的利用并非由基层医疗满意度低或急诊科满意度高所驱动。仅提高满意度是不够的，还需要解决过度使用、适应不良的就医行为以及家庭健康中心标准化医疗设备和充足人力资源的结构性需求，而不是仅仅依赖分类分组。
