Journal of General Internal Medicine

, Volume 34, Issue 11, pp 2610–2619 | Cite as

Reasons Patients Choose the Emergency Department over Primary Care: a Qualitative Metasynthesis

  • Jody A. VogelEmail author
  • Kristin L. Rising
  • Jacqueline Jones
  • Marjorie L. Bowden
  • Adit A. Ginde
  • Edward P. Havranek
Review Paper



To enhance the acute care delivery system, a comprehensive understanding of the patient’s perspectives for seeking care in the emergency department (ED) versus primary care (PC) is necessary.


We conducted a qualitative metasynthesis on reasons patients seek care in the ED instead of PC. A comprehensive literature search in PubMed, CINAHL, Psych Info, and Web of Science was completed to identify qualitative studies relevant to the research question. Articles were critically appraised using the McMaster University Critical Review Form for Qualitative Studies. We excluded pediatric articles and nonqualitative and mixed-methods studies. The metasynthesis was completed with an interpretive approach using reciprocal translation analyses.


Nine articles met criteria for inclusion. Eleven themes under four domains were identified. The first domain was acuity of condition that led to the ED visit. In this domain, themes included pain: “it’s urgent because it hurts,” and concern for severe illness. The second domain was barriers associated with PC, which included difficulty accessing PC when ill: “my doctor said he was booked up and he instructed me to go to the ED.” The third domain was related to multiple advantages associated with ED care: “my doctor cannot do X-rays and laboratory tests, while the ED has all the technical support.” In this domain, patients also identified 24/7 accessibility of the ED and no need for an immediate copay at the ED as advantageous. The fourth domain included fulfillment of medical needs. Themes in this domain included the alleviation of pain and the perceived expertise of the ED healthcare providers.


In this qualitative metasynthesis, reasons patients visit the ED over primary care included (1) urgency of the medical condition, (2) barriers to accessing primary care, (3) advantages of the ED, and (4) fulfillment of medical needs and quality of care in the ED.


primary care healthcare delivery access to care qualitative research metasynthesis patient preferences patient-centered care 



There are no contributors to the manuscript that did not meet authorship criteria. Specific contributions were as follows: study concept and design: JAV, JJ, and EPH; acquisition of data: JAV, KLR, JJ, and MLB; analysis and interpretation of data: JAV, KLR, JJ, MLB, AAG, and EPH; drafting of the manuscript: JAV; critical revision of the manuscript for important intellectual content: JAV, KLR, JJ, MLB, AAG, and EPH; statistical analysis: JAV, KLR, JJ, and MLB; obtained funding: JAV; administrative, technical, or material support: JAV and EPH.


This study was supported in part by the Agency for Healthcare Research and Quality (Dr. Jody Vogel [K08HS023901]).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Jody A. Vogel
    • 1
    • 2
    • 3
    Email author
  • Kristin L. Rising
    • 4
  • Jacqueline Jones
    • 5
  • Marjorie L. Bowden
    • 6
  • Adit A. Ginde
    • 1
    • 2
  • Edward P. Havranek
    • 3
    • 7
    • 8
  1. 1.Department of Emergency MedicineDenver Health Medical CenterDenverUSA
  2. 2.Department of Emergency MedicineUniversity of Colorado School of MedicineAuroraUSA
  3. 3.Center for Health Systems ResearchDenver Health Medical CenterDenverUSA
  4. 4.Department of Emergency MedicineThomas Jefferson UniversityPhiladelphiaUSA
  5. 5.College of NursingUniversity of ColoradoAuroraUSA
  6. 6.School of Social WorkUniversity of MichiganAnn ArborUSA
  7. 7.University of Colorado School of MedicineAuroraUSA
  8. 8.Department of MedicineDenver Health Medical CenterDenverUSA

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