Does Patient Satisfaction with Primary and Emergency Care Influence Non-Urgent Emergency Department Utilization? A Path Analysis

İbrahim Sarbay,1 Melike Mercan Baspinar,2 Ezgi Erman,1 Bilge Cavdar,1 Ilayda Tamer,1 Ayla Muge Adiyaman,2 Kafkas Kosali,2 Muhammed Yasar Aksuz,1 Okcan Basat,2 Mustafa Calik1 1Department of Emergency Medicine, University of Health Sciences, Gaziosmanpaşa Training and Research Hospital, Istanbul, Türkiye; 2Department of Family Medicine, University of Health Sciences, Gaziosmanpaşa Training and Research Hospital, Istanbul, TürkiyeCorrespondence: Melike Mercan Baspinar, Email [email protected]: To examine whether patient satisfaction mediates the relationship between primary care (PC) utilization and non-urgent emergency department (ED) use during weekday working hours.Methods: This observational study compared patient satisfaction levels using two validated tools: the EUROPEP (European Patients Evaluate General/Family Practice) scale for PC visits and the Brief Emergency Department Patient Satisfaction Scale (BEPSS) for ED visits. Data analysis was conducted using Jamovi software (version 2.6.26), employing structural equation modeling and correlation analysis.Results: A total of 293 non-urgent adult patients (61.4% female) were enrolled in the study through consecutive sampling at ED visits of a tertiary hospital in Istanbul. Visits solely for examination purposes constituted 43.7% of PC visits and 66.6% of ED visits. Patient satisfaction rates were 66.7% for PC and 75.0% for ED. Frequent users of non-urgent ED services were also more likely to utilize PC services (r = 0.394, p ≤ 0.001). A positive correlation was observed between satisfaction with previous PC and ED experiences (r = 0.399, p ≤ 0.001). However, higher satisfaction with either service was not associated with increased visit frequency (p > 0.05). Notably, frequency of PC visits mediated the relationship between older age and increased non-urgent ED use (β = 0.067, 95% CI [0.002, 0.029], p = 0.028), suggesting insufficient referrals from PC to ED.Conclusion: Non-urgent ED utilization during working hours is not driven by low PC satisfaction or high ED satisfaction. Improving satisfaction alone is insufficient without addressing overuse, maladaptive health-seeking behavior, and the structural need for standardized medical equipment and adequate human resources in family health centers—rather than relying solely on categorical group classifications.Keywords: emergency medical services, primary health care, patient satisfaction, non-urgent