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

Almost half with perceived ‘urgent’ problem wind up in ED (December 30)

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 new data from the Center for Studying Health System Change (CSHSC).

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 study, which was based on the 2012 Autoworker Health Care Survey. The survey of 8,836 active and retired nonelderly autoworkers and spouses — while not nationally representative — provided an opportunity to examine why privately insured people decide to go to EDs when faced with an urgent medical problem.

Nearly a quarter of the respondents (23%) reported having an urgent medical problem in the 3 months before the survey, and almost half (44%) of those with an urgent condition ultimately went to an ED for treatment. 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, most respondents indicated that they lacked this level of primary care access.

Key findings include:

  • Nearly half of the respondents (49%) reported going to an ED in part because they believed their medical problem was an emergency and required immediate attention. Thirty percent indicated this was their sole reason — by far the most common response.
  • About 7% of respondents indicated that using an ED was driven partially by convenience, but less than 2.5% cited convenience as the sole reason for choosing an ED.
  • About one in four people (24.8%) reported that their doctor’s office was closed when they needed help, and a similar percentage (24.1%) indicated that their physician instructed them to go to an ED.

Source: CSHSC; December 30, 2013.

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