Determinants of emergency department use by patients with non-urgent conditions and with or without a usual source of care

摘要

PURPOSE: Achieving the objective of better integration and coordination of care by the health care delivery system had been quite challenging. Many patients do not have a usual place of care while those patients who have a usual source of care do not fully utilize it for primary care services. The purpose of this study is to determine the characteristics of patients with or without a usual source of care that use hospital ED services for primary care related /non urgent diseases and their reasons for ED use.;METHOD: This study was a cross sectional study which used De-identified data from LBJ efficiency project survey database between the periods of May 2013 to July 2013. 570 eligible patients 18 years and older that had been triage to ESI levels 3- 5 were extracted for the study. We used bi-variate analysis and ordered logistic regression analysis to identify the differences in the determinants of ED use by patients with or without a usual source of care.;RESULTS: 565 patients participated in the survey of which 51.86% had a usual source of care. 48.30% of the low acuity patients do not have a usual source of care because of lack of insurance and inability to afford primary care cost (P<0.00). The differences in the frequency of ED use over the year among patients with or without a usual source of care were found to be significant for race, unemployment, lack of insurance, chronic conditions, close proximity, after hours, need no appointment and pain. Having at least one barrier to timely medical care does not explain the reason why patients with a usual source of care will likely visit the ED (P<0.06).;CONCLUSIONS: There is a common finding between patients not having a usual source of care and their reliance on ED for care which is lack of insurance. Low acuity patients with chronic health conditions who have a usual source of care visit the ED more than those without a usual source of care and their pain perception and convenience are strong determinants for frequent ED visits rather than the identified access barriers to primary care. Introduction of health education on pain management and access to healthcare services at the ED is encouraged. Policymakers need to work on how we can achieve a universal coverage that is considerate of the low or middle class. They should look into ways of improving ED capacity and access to care at both the primary and ED services especially with the upcoming ACA related increases in coverage otherwise overcrowding at the ED will remain an unsolved issue.