Neighborhood variations in the use of hospital emergency rooms for primary care

The purpose of the paper is to analyze neighborhood variations in the use of emergency rooms (ERs) as settings for primary care within Oklahoma County, part of the Oklahoma City MSA. The location of patients taken from a sample of ER records in four large hospitals were aggregated to census tracts. Tract visitation rates were estimated and related to the socio-economic character and the relative location of the tracts for two periods--'physicians' office hours' and 'non-office hours'. The results show that for the city as a whole primary care use in emergency rooms is associated with the socio-economic status and relative location of a residential area. Tracts with lower socio-economic status have higher rates of emergency rooms use for primary care than those of higher status. This relationship is true both during physicians' office hours as well as during the times their offices are closed. When visitation rates are analyzed separately for individual hospitals, location rather than neighborhood socio-economic characteristics is paramount. It was concluded that while primary care visits to emergency rooms are higher in lower socio-economic status neighborhoods, and that this is a function of the more accessible location of emergency rooms to these neighborhoods as well as to socio-economic effects on use.