Keywords: emergency medical care

Background:

Patients’ perceptions of access to emergency and non-emergency services are essential to evaluating the functioning of general practice and emergency systems. In Bulgaria, patients are entitled to 24/7 care. Out-of-hours services are organized by GPs, who may deliver the service themselves or contract another provider, with state funding per registered patient. Contact information must be posted at the GP’s office, giving patients access to their GP or the designated out-of-hours unit. Despite this structure, some patients bypass primary care and seek help directly from emergency services.

Research questions:

Does the patient’s health status and access to care influence their decision to seek emergency services instead of contacting their GP?

Method:

A cross-sectional quantitative study was conducted among 168 adult patients who visited general practices in the districts of Pleven, Lovech, and Svishtov. Participants were randomly selected from patient lists and completed an anonymous, structured 29-item questionnaire. The survey included questions on demographics, perceived urgency, access to the GP or out-of-hours services, and use of Emergency Medical Servises (EMS) or Emergency Department (ED). Data were collected over three months and analyzed using SPSS v25. Descriptive statistics and non-parametric tests (Chi-square, Mann–Whitney U) explored associations, with significance set at α = 0.05.

Results:

Of all respondents, 55% had either called 112 or experienced difficulty contacting their GP or duty office. Key reasons for bypassing primary care included uncertainty about the urgency of their condition (57.6%), lack of accessible duty offices (17.6%), and expectations of broader diagnostic access at EDs (13.6%).

Conclusions:

Limited awareness of appropriate access routes leads to overuse of emergency services. Improved patient education and better coordination between GPs and emergency services may enhance care navigation.

Points for discussion:

What strategies have proven effective in other countries to improve patient use of out-of-hours care pathways?