Multilevel logistic regression model of determinants of inappropriate use of EDs
| Appropriate use score method | Possible GP use method | Resource utilisation method | |||||||
| aOR | 95% CI | aOR | 95% CI | aOR | 95% CI | ||||
| Patient characteristics | |||||||||
| Age, years | |||||||||
| 15–24 | Ref | Ref | Ref | ||||||
| 25–34 | 0.799 | 0.716 | 0.891 | 0.810 | 0.732 | 0.895 | 0.872 | 0.767 | 0.990 |
| 35–44 | 0.721 | 0.642 | 0.809 | 0.708 | 0.636 | 0.787 | 0.755 | 0.658 | 0.865 |
| 45–54 | 0.640 | 0.568 | 0.722 | 0.595 | 0.533 | 0.665 | 0.710 | 0.616 | 0.817 |
| 55–64 | 0.556 | 0.490 | 0.631 | 0.485 | 0.431 | 0.546 | 0.509 | 0.434 | 0.598 |
| 65–74 | 0.475 | 0.406 | 0.555 | 0.413 | 0.356 | 0.478 | 0.401 | 0.325 | 0.495 |
| 75–84 | 0.344 | 0.292 | 0.406 | 0.296 | 0.253 | 0.347 | 0.240 | 0.188 | 0.307 |
| >85 | 0.242 | 0.196 | 0.300 | 0.237 | 0.194 | 0.288 | 0.136 | 0.094 | 0.199 |
| Sex | |||||||||
| Male | Ref | Ref | Ref | ||||||
| Female | 1.242 | 1.160 | 1.331 | 1.270 | 1.192 | 1.354 | 1.133 | 1.040 | 1.233 |
| Supplementary health insurance | |||||||||
| Private | Ref | Ref | Ref | ||||||
| Universal complementary health coverage | 1.150 | 1.014 | 1.305 | 1.190 | 1.058 | 1.338 | 1.331 | 1.150 | 1.541 |
| None | 1.342 | 1.170 | 1.539 | 1.160 | 1.018 | 1.322 | 1.268 | 1.075 | 1.497 |
| Health insurance | |||||||||
| Public health insurance | Ref | Ref | Ref | ||||||
| None or state medical assistance | 1.192 | 0.932 | 1.525 | 1.142 | 0.905 | 1.441 | 1.241 | 0.943 | 1.632 |
| Employment status | |||||||||
| Employed | Ref | Ref | Ref | ||||||
| Unemployed | 1.044 | 0.921 | 1.184 | 0.899 | 0.798 | 1.012 | 0.964 | 0.831 | 1.120 |
| Inactive | 0.956 | 0.865 | 1.056 | 0.875 | 0.798 | 0.961 | 0.906 | 0.804 | 1.022 |
| Level of education | |||||||||
| High-school graduation or less | Ref | Ref | Ref | ||||||
| More than high-school graduation | 0.889 | 0.813 | 0.972 | 0.919 | 0.847 | 0.997 | 0.943 | 0.847 | 1.050 |
| Residence | |||||||||
| Home | Ref | Ref | Ref | ||||||
| Institution | 0.798 | 0.613 | 1.038 | 0.629 | 0.483 | 0.820 | 0.661 | 0.445 | 0.982 |
| Other | 0.858 | 0.647 | 1.138 | 0.705 | 0.535 | 0.928 | 0.744 | 0.523 | 1.058 |
| Having a GP | |||||||||
| No | Ref | Ref | Ref | ||||||
| Yes | 0.902 | 0.784 | 1.038 | 0.859 | 0.755 | 0.978 | 0.926 | 0.786 | 1.091 |
| ED visit characteristics | |||||||||
| Onset of complaint | |||||||||
| The day of ED visit | Ref | Ref | Ref | ||||||
| Before the day of ED visit | 2.094 | 1.951 | 2.248 | 1.535 | 1.439 | 1.638 | 1.499 | 1.374 | 1.635 |
| Time of ED arrival | |||||||||
| 08:00–20:00 | Ref | Ref | Ref | ||||||
| 20:00–08:00 | 1.083 | 0.999 | 1.175 | 1.170 | 1.086 | 1.260 | 1.358 | 1.234 | 1.494 |
| Distance from home to ED | |||||||||
| ≤10 km | Ref | Ref | Ref | ||||||
| >10 km | 0.886 | 0.822 | 0.955 | 0.850 | 0.794 | 0.911 | 0.831 | 0.758 | 0.912 |
| ED characteristics | |||||||||
| Type of hospital visited | |||||||||
| Public academic | Ref | Ref | Ref | ||||||
| Public non-academic | 1.253 | 0.998 | 1.573 | 1.198 | 1.011 | 1.421 | 1.025 | 0.824 | 1.275 |
| Not-for-profit private | 0.953 | 0.681 | 1.334 | 0.844 | 0.655 | 1.089 | 0.880 | 0.635 | 1.219 |
| For-profit private | 0.659 | 0.498 | 0.872 | 0.722 | 0.585 | 0.892 | 0.871 | 0.665 | 1.141 |
| Annual visits for the ED visited | |||||||||
| ≤15 000 | Ref | Ref | Ref | ||||||
| 15 000–30 000 | 1.234 | 1.020 | 1.493 | 1.008 | 0.869 | 1.169 | 0.826 | 0.683 | 1.001 |
| 30 000–45 000 | 1.187 | 0.954 | 1.478 | 1.042 | 0.881 | 1.232 | 0.783 | 0.630 | 0.973 |
| >45 000 | 1.329 | 1.044 | 1.692 | 1.033 | 0.859 | 1.241 | 0.958 | 0.758 | 1.212 |
| County medical density | |||||||||
| Low | Ref | Ref | Ref | ||||||
| Intermediate to high | 1.010 | 0.873 | 1.170 | 0.983 | 0.879 | 1.099 | 1.002 | 0.868 | 1.158 |
Significant results are in light colour (versus non-significant in dark colour).
aOR, adjusted OR; ED, emergency department; GP, general practitioner; Ref, reference.