Access to Care/Health Care Delivery

Greater access to primary care may reduce emergency department use

Emergency department (ED) visits in the United States have ballooned in the past decade, with many of these visits substituting for primary care. Greater primary care access and scope of services may reduce ED use, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS09261). Robert A. Lowe, M.D., M.P.H., of Oregon Health and Science University, and colleagues studied ED use among 57,850 patients assigned to 353 primary care practices affiliated with a Medicaid HMO to determine if practice characteristics were associated with ED use.

Patients from practices with more than 12 evening hours per week used the ED 20 percent less often than patients from practices without evening hours. Patients from practices that had weekend hours also used the ED less, but the trend was not significant. Patients also used the ED less often when their providers had a greater number of hours to address patients needs. Medicaid patients used the ED more often when their primary care practice had a higher percentage of Medicaid patients and in practices with nurse practitioners or physician assistants.

Whether or not practices had equipment for asthma care also influenced ED use. For instance, practices lacking nebulizers for bronchodilators had 13 percent higher overall ED use by children and 24 percent higher ED use by children with respiratory conditions. Similarly, practices lacking peak flow meters had 15 percent higher overall ED use by adults and 20 percent higher ED use for adults with respiratory conditions.

More details are in "Association between primary care practice characteristics and emergency department use in a Medicaid managed care organization," by Dr. Lowe, A. Russell Localio, J.D., M.S., Donald F. Schwarz, M.D., M.P.H., M.B.A., and others, in the August 2005 Medical Care 43(8), pp. 792-800.

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