Nonurgent Emergency Department Use Among Women Sentenced to Probation

Like women who are incarcerated, women sentenced to probation have high levels of physical and mental health morbidities. They rely heavily on hospital emergency departments (EDs) for health care in community settings. We examined the prevalence of nonurgent ED use in a cohort of women with a history of probation system involvement in Alameda County, California. We found that two-thirds of ED visits were nonurgent, even though most women had health insurance. Factors associated with nonurgent ED use included having one or more chronic health conditions, severe substance use, low health literacy, and recent arrest. Among a subgroup of women who also received primary care, dissatisfaction with a recent primary care visit was also associated with nonurgent ED use. The heavy use of the ED for nonurgent care in this study may reflect a need to provide options better attuned to the multiple forms of instability and barriers to wellness faced by women with criminal legal system involvement.