However, male gender is statistically significantly associated with increased odds of at least one emergency department visit in the analysis stratified by more TGX 221 severe cases. This result indicates the importance of stratifying our analyses according to the severity of the triage scale, as the factors influencing the emergency department utilization may vary as a function of the severity of a cases initial presentation. The impact of access to a primary care physician on emergency department utilization rates is an interesting finding in our analysis. Once again, the impact of this covariate differs according Inhibitors,research,lifescience,medical to the severity of presentation. For more severe

cases (triage scale 1-3), having access to a family Inhibitors,research,lifescience,medical doctor did not influence the odds of emergency department utilization, nor did it impact the rate of utilization in those who demonstrated positive demand for the service over the study interval. For less severe emergency department visits (triage scale 4-5) we estimate that having access to a primary care provider significantly reduces the likelihood (OR = 0.69) of a visit. Further, given that a visit occurs, the rate of utilization is also significantly lower in those with Inhibitors,research,lifescience,medical access to a primary care provider (RR = 0.57). From a policy perspective,

this finding suggests that having access to a primary care provider has the opportunity to reduce more than 40 percent of less urgent emergency department visits. Hence, strategies to increase the supply/access to primary health care professionals may result in reduced demand for emergency department services and fewer issues related to crowding, wait times and variable quality of care in Ontario’s emergency departments. To our knowledge this Inhibitors,research,lifescience,medical study is a unique population based Canadian study, which links a large national survey to

provincial health utilization databases to assess the impact of individual level characteristics on the emergency department Inhibitors,research,lifescience,medical demand. Our sample size is large and outcome measures are complete. Results of this study are based on regression models that are theoretically appropriate and statistically had the best fit compared to other potential models which were investigated. Some of the findings of this study have important policy implications and if adopted may result in reducing the number of less urgent Tolmetin emergency department visits that are occurring in Ontario. One limitation of our study is that we did not examine the impact of contextual factors, such as: accessibility to nearby walk in clinics, the number of primary care providers in a respondents’ census tract or postal code region or the distance to nearest emergency department at the area level. Nor did we stratify our analyses according to other pertinent factors, such as: the day of the week (weekday versus weekend) or the time of the day.