Association Between Primary Care Access and Emergency Department Utilization

To examine the association between primary care pediatrician (PCP) access and emergency department (ED) utilization and reliance for children, and to determine whether lack of PCP, limited after hour availability, and greater distance to care would be associated with higher ED utilization and reliance.

We performed a retrospective, cross-sectional study of nonelective visits for children <18 years old in 2021-2022, utilizing the nationally representative Medical Expenditure Panel Survey. Primary outcomes were frequent ED utilization (>2 emergency visits annually) and high ED reliance (one-third or more of all medical visits occurring in the ED). We assessed the relationship between PCP access and the outcomes using logistic regression, adjusting for age, sex, race and ethnicity, and special health care need.

We included 9878 surveyed children, who were representative of 72 549 476 children nationally. A total of 60 353 592 (83.2%) children had identified PCP. Lack of PCP was associated with high ED reliance (aOR 1.78, 95% CI 1.26-2.50) but showed no significant association with frequent ED utilization (aOR 0.60, 95% CI 0.34-1.08). Among children with identified PCP, neither travel time to PCP, ease of contact with phone or email, ease of contact after hours, nor night-time and weekend availability was associated with either outcome.

Lack of PCP is strongly associated with greater reliance on the ED as a source of medical care, but not with frequent ED utilization. Policymakers can use these data to tailor programs to the needs of specific groups that would most benefit from improved access to care.