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Health Care Access/Use

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Heavy users of the ER are usually socioeconomically disadvantaged and have significant health problems

Increased patient volume and more severely ill patients have led to overcrowding of U.S. emergency departments (EDs). A small group of patients account for a disproportionate number of ED visits (four or more visits). These heavy ED users are more likely to be socioeconomically disadvantaged, suffer from chronic illness, and have high use of other health services than other ED users, concludes a study by Helen R. Burstin, M.D., M.P.H., of the Agency for Healthcare Research and Quality, and colleagues.

The researchers analyzed ED intake surveys, medical charts, and telephone followup interviews with 2,333 patients with select chief complaints at five urban EDs during one month in 1995. Sociodemographic predictors of frequent ED use were being a single parent, being single or divorced, having a high school education or less, and earning less than $10,000 a year. Health predictors were hospitalization in the preceding 3 months, high ratings of psychological distress, and asthma. Predictors related to access to care included identifying an ED or a hospital clinic as the primary care site, having a primary care physician (PCP), and visiting a PCP in the past month. The sole health preference predictor was preferring the ED for free care.

Although frequent ED users were more severely ill than less frequent ED users, illness severity measures were not independently predictive of heavy ED use. Presence or type of health insurance was not a predictor of heavy ED use. Frequent visitors were no more willing to defer their ED visit for a clinic appointment or due to a required copayment than other patients. Thus, other approaches besides ED copayments and increased clinic availability will be needed to meet the unique needs of these patients in the emergency and primary care settings.

More details are in "Predictors and outcomes of frequent emergency department users," by Benjamin C. Sun, M.D., M.P.P., Dr. Burstin, and Troyen A. Brennan, M.D., J.D., M.P.H., in the April 2003 Academic Emergency Medicine 10, pp. 320-328.

Reprints (AHRQ Publication No. 03-R038) are available from the AHRQ Publications Clearinghouse.

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