Emergency department utilization among Hispanic and African-American under-served patients with type 2 diabetes

To examine emergency department (ED) use among a sample of 349 low-income Hispanic and African-American patients with type 2 diabetes. The study used a theoretical model to conceptualize health services utilization as the end product of predisposing, enabling, and need-for-care characteristics.

Cross-sectional sampling of consecutive subjects with diabetes attending 7 inner-city clinics that provide primary medical care to low-income residents in South Central Los Angeles.

Three hundred and forty-nine patients (Hispanics [67.3%] and African Americans [32.7%]) with type 2 diabetes.

Thirty-two percent of this sample reported one or more visits to the ED for medical care within the 12-month period prior to the interviews. Moreover, 11.5% of the patients reported visiting the ED more than once and 4.6% of the patients admitted visiting the ED more than 2 times within the same 12-month period. In a staged path analysis, ED use was significantly predicted by the predisposing variables of younger age, female gender, African-American ethnicity, and less education as well as the enabling variable of ability to pay. In addition, the need variables of insulin injection and number of diabetes-related complications were also significantly related to ED utilization.

Emergency department (ED) utilization is considered to be closely linked to a patient's need-for-care characteristics. However, our study shows that the predisposing characteristics of participants with diabetes explained about the same amount of variance as need-for-care characteristics. The higher-than-anticipated importance of predisposing characteristics suggest that intervention strategies, which specifically target patients with these characteristics, should be a part of any broad approach to reducing ED use among patients with type 2 diabetes.