In the United States, there is an issue with low-income uninsured patients using emergency services for nonurgent conditions instead of using primary care services. Primary care services are more beneficial than emergency services for such patients, in that they can receive continual or follow-up care through primary care and thus achieve better health outcomes over the long term. Though information is available concerning factors in (or the rationale for) low-income uninsured patients choosing the emergency department (ED) instead of primary services for nonurgent conditions, research focusing on low-income uninsured patients' perspectives, beliefs, and level of knowledge about this matter is missing from the literature. The purpose of this qualitative phenomenological study was to gain an understanding of the perspectives, beliefs, and level of knowledge of low-income uninsured patients about primary care services and to explore whether patient education can improve access to primary care. The health belief model was used to explore 6 concepts: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. Criterion sampling was used to recruit 10 participants, an interview tool was used to collect data, and the data was analyzed deductively. Results revealed that members of the low-income uninsured population believed primary care to be better than the ED because it offers cost-effectiveness, preventative care, efficiency, and familiarity. Results indicated that lack of money or insurance prevented participants from using primary services. This study may bring awareness that leads to the improvement of patient education and navigation, the reduction of ED usage, and an increase in primary care utilization.

Les pays occidentaux ont connu un accroissement des consultations des services d'urgence (SU). Les deux causes avancées sont la modification du comportement des usagers avec l'augmentation des demandes de soins « non-urgentes » (NU) et l'insuffisance de l'offre de soins dans le secteur libéral. L'objectif de cette thèse est d'analyser la hausse de la fréquentation des SU à travers la problématique des patients NU. Pour répondre aux questionnements, une analyse de la littérature internationale et une étude des comportements des usagers ont été réalisées.Le pourcentage de consultations NU se situerait autour de 30%. Les tendances résultent de l'hétérogénéité de la définition de la NU, qui se traduit par l'hétérogénéité des critères de tri et des méthodes de recueil. Le profil du consultant NU n'est pas celui attendu, tel qu'il est décrit classiquement dans les représentations collectives. L'usager est une personne rationnelle. La décision du recours est le fruit d'un arbitrage entre risques concurrents, par un individu acteur de sa propre existence, qui prend une décision individuelle dans un système de soins qu'il connaît et dont il identifie les limites. L'absence de définition consensuelle de ce qui constitue une « urgence », le manque d'outils de triage fiables pour la reconnaître et de consensus sur le rôle exact des SU, expliquent la difficulté à identifier le patient NU et conduit actuellement à l'incapacité de légitimer la réorientation des patients vers des structures de soins alternatives. Face à ce constat, faut-il poursuivre les actions visant à diminuer le nombre de consultations NU dans les SU ou, au contraire, les accepter et les gérer ? / Emergency Departments (ED) utilization has increased inducing ED overcrowding in many countries. The reasons for ED overcrowding are related partly to misuse of EDs on the part of patients who seek care for nonurgent (NU) problems, and inaccessibility to primary care services. Because the problem of NU ED visits is quite complex, the objective of this thesis was to conduct a critical review of the literature to better understand the conceptual and methodological questions of NU, and to explore why people with NU complaints choose to come to the EDs instead of their primary care provider. The proportion of NU ED visits would be around 30%. The review has highlighted the lack of reliability and reproducibility of methods of categorization. The profile of the consultant NU is not the expected one, as described usually in the collective social representations. The patient behaved as “rational person” when choosing to go to the ED. Among all health care resources available, the ED is the most suitable place and the most efficient provider for their medical needs. ED patients were willing to optimize their medical care by considering the most efficient health care resources. The lack of consensus on methods of categorization and criteria and the confusion between the concepts of NU and inappropriate ED visits explain the difficulty to identify the NU patient. Therefore none methods of categorization should be used to redirected patients outside the ED.