Use of Emergency Room Care over Primary Care for Non-Urgent Issues



Use of Emergency Room Care over Primary Care for Non-Urgent Issues

Thesis

If working Americans who make an income that exceeds the low poverty limit were covered, perhaps there would be more utilization of primary care to manage patients instead of patients going to the emergency room for care.

Introduction

Emergency department (ED) use across the country has risen 20% since 1995, reaching 115.3 million visits in 2005. At the same time, 9.1% of operating EDs have closed, decreasing from 4,176 in 1995 to 3,795 in 2005 (Nawar, Niska, & Xu, 2007). Therefore, EDs are faced with overcrowding leading to longer wait times and restricted access to needed ambulatory care (Richardson & Hwang, 2001a). In addition, EDs are legally obligated under the mandate, EMTALA (Emergency Medical Transport and Liability Act), to see and evaluate any patient that presents for treatment regardless of the complaint. Patients who come to the ED with minor complaints are contributing to the current problems of overcrowding. According to data from the National Hospital Ambulatory Medical Care Survey, in 2005, non-urgent patients comprised 13.9% of ED visits (Nawar et al., 2007), an increase of 10.7% from 2000 (McCaig & Ly, 2002).

Others have estimated the incidence of non-urgent usage as high as 50% (Guttman, Zimmerman, & Nelson, 2003). Also, minor care patients tend to have longer wait times due to the low priority of the presenting complaints. Care for this population can be episodic and fragmented, focusing only on the presenting issue and not on the entire health of the individual. EDs typically focus on the care of the ill patient, and do not have prevention as their primary focus. Frequently, non-urgent patients may not get the continuity of care that is attributed to primary care providers. However, clinics or primary care provider offices may be difficult to access due to the requirement of a copay, limited office hours, and multiple day waits to get an appointment (Guttman et al., 2003).

The ED does not require upfront payment at the time of the visit and is always available. Non-urgent patients are self-identifying their healthcare needs and seeking care in response to those needs, regardless if the visit is viewed as a potential inefficient utilization of health care resources. Therefore, the patients' themselves are deciding what constitutes an emergency, even though this might be incongruent with how the healthcare provider may distinguish an emergency. Each hospital has a legal and community obligation to address the healthcare needs of all patients, regardless of whether or not the visit is deemed “appropriate.” In order to better treat this group of patients and ensure proper education and follow up, it is important to investigate more about the reasons that drive patient decision-making to utilize the ED.

Previously, the research has identified reasons for non-urgent visits according to convenience, difficulty accessing care elsewhere, patients' perceived urgency of their condition, and preference for better care/familiarity (Afilalo, Marinovich, Colacone, Leger, Unger, & Giguare, 2004; Guttman et ...