Email updates

Keep up to date with the latest news and content from BMC Health Services Research and BioMed Central.

Open Access Research article

Factors associated with the utilization of primary care emergency centers in a Spanish region with high population dispersion: a mixed-methods study

Belén Sanz-Barbero12*, Laura Otero-García12, Teresa Blasco-Hernández3 and Miguel San Sebastián4

  • * Corresponding author: Belén Sanz-Barbero

  • † Equal contributors

Author Affiliations

1 National School of Public Health, Health Institute Carlos III, Madrid, Spain

2 CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain

3 National Centre of Tropical Medicine, Health Institute Carlos III, Madrid, Spain

4 Department of Public Health and Clinical Medicine Umeå University, Umeå International School of Public Health, Umeå, Sweden

For all author emails, please log on.

BMC Health Services Research 2014, 14:368  doi:10.1186/1472-6963-14-368

Published: 3 September 2014



Adequate access to primary care emergency centers is particularly important in rural areas isolated from urban centers. However, variability in utilization of emergency services located in primary care centers among inhabitants of nearby geographical areas is understudied. The objectives of this study are twofold: 1) to analyze the association between the availability of municipal emergency care centers and utilization of primary care emergency centers (PCEC), in a Spanish region with high population dispersion; and 2) to determine healthcare providers’ perceptions regarding PCEC utilization.


A mixed-methods study was conducted. Quantitative phase: multilevel logistic regression modeling using merged data from the 2003 Regional Health Survey of Castile and Leon and the 2001 census data (Spain). Qualitative phase:14 in-depth- interviews of rural-based PCEC providers.


Having PCEC as the only emergency center in the municipality was directly associated with its utilization (p < 0.001). Healthcare providers perceived that distance to hospital increased PCEC utilization, and distance to PCEC decrease its use. PCEC users were considered to be predominantly workers and students with scheduling conflicts with rural primary care opening hours.


The location of emergency care centers is associated with PCEC utilization. Increasing access to primary care by extending hours may be an important step toward optimal PCEC utilization. Further research would determine whether lower PCEC use by certain groups is associated with disparities in access to care.

Primary care emergency center; Health services utilization; Mixed-methods approach, Spain