Patients’ Sense of Urgency — Not Convenience — Contributes to ED Use

Contrary to the idea that convenience prompts many privately insured people to seek care in emergency departments (EDs), the people most likely to use EDs believe they urgently need medical attention, according to a new study by the Center for Studying Health System Change (HSC).

Patients’ perception of the severity of their medical problem and who they first contact for help or advice are the factors most associated with whether they seek emergency care, according to the HSC study based on NIHCR’s 2012 Autoworker Health Care Survey, which had a 64.2 percent response rate. The survey of 8,836 active and retired nonelderly autoworkers and spouses — while not nationally representative — provides a unique opportunity to examine why privately insured people decide to go to EDs when faced with an urgent medical problem. Of people with an urgent problem, nearly half first contacted their regular source of care — typically a primary care clinician — and those patients were less likely to go to EDs, the study found.

Only rarely did respondents cite convenience as a reason for choosing ED care. Moreover, people who reported that their primary doctor offered rapid access to advice and visits were significantly less likely to use EDs and instead relied on their primary clinician for urgent medical needs. However, despite their relatively comprehensive health coverage, the majority of respondents indicated they lacked this level of primary care access.

Other key findings include:

  • Nearly half of respondents (49 percent) reported going to an ED in part because they believed their medical problem was an emergency and required immediate attention. And 30 percent indicated this was their sole reason, by far the most common response.
  • Relatively few people cited convenience as a factor in deciding to go to an ED. About 7 percent indicated using an ED was driven partially by convenience, but less than 2.5 percent cited convenience as the sole reason for choosing an ED.
  • About one in four people (24.8 percent) reported their doctor’s office was closed when they needed help, and close to a quarter (24.1 percent) indicated their physician instructed them to go to an ED.
  • When first deciding to seek medical care for an urgent problem—either a new problem or aggravation of an existing problem—nearly half of all patients first contacted their physician for help or advice. Another 20 percent called 911 or went straight to the ED, and 17 percent first contacted or visited an urgent care center.
  • People with coverage through a health maintenance organization (HMO) were more likely to contact their doctor when seeking urgent care (52 percent versus 43 percent) and were less likely to call 911 or go straight to the ED (17 percent versus 22 percent).
  • Overall, those who first contacted their doctor were much less likely to go to an ED than other people. Among the 75 percent of patients with an urgent need who contacted a doctor’s office or clinic, nearly 60 percent were treated by a doctor or nurse in an office setting and another 12 percent were able to have their issue managed over the phone.

Source: Center for Studying Health System Change, December 30, 2013

27 Interventions to Reduce Avoidable ER Use

27 Interventions to Reduce Avoidable ER Use describes 27 separate initiatives launched by Kaiser Foundation Health Plan and WellPoint around the country that are effectively reducing avoidable emergency department use and redirecting patients to more cost-effective care venues.

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