Abstract
The population is increasingly using emergency care services around the world. The underlying interrogation is whether this increase is a consequence from a dysfunction in healthcare provision, from a deterioration in the health status of the population or from socioeconomic determinants.
We performed geospatial analyses with 3-year 1,081,026 Emergency Medical Services (EMS) responses in Paris and its suburbs. Incidence of calls per population and complaints were compared, at the neighborhood level, with demographic and socioeconomic determinants. Associations with characteristics of the health system such as the density of primary care doctors were also studied. Spatial autocorrelations were searched with Moran's I analyses.
We found a positive correlation between the incidence of EMS calls by population for respiratory problems, and the level of poverty as well as the unemployment rate (p < 0.001). There was no significant correlation between psychiatric complaints and socioeconomic determinants. There was a strong correlation between calls for birth or imminent birth by woman of childbearing age and the unemployment rate among women, the unemployment rate overall and household median household income (p < 0.001). There was no correlation between the density of primary care providers and EMS activity by population.
EMS data allowed us to powerfully identify specific socioeconomic determinants of health for a 7 million-inhabitant population at the district level. Results could be used to design and implement tailored public health interventions for maximum impact. The overuse of emergency services does not seem to stem solely from the decrease in the supply of primary care doctors. Innovatively, monitoring the actual use of emergency services could responsively inform policy makers and agencies responsible for prevention and health promotion about the specific needs of the population and the consequences of decisions on the organization of the provision of care.
Key messages
The use of emergency services is a valid metric to evaluate the health status of the population and identify socioeconomic determinants. It gives specific guidelines for public health interventions. Geospatial analyses can efficiently identify the specific needs of a population at the neighborhood level. It can participate to the evaluation of the organization of healthcare provision.
Establishment and Performance of Hospitalist Team in the Young Primary Care Doctors Division of the Japan Primary Care Association
