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Primary care and public emergency department overcrowding
K Grumbach1, D Keane, A Bindman
1Department of Family and Community Medicine, San Francisco General Hospital, CA 94110.
American Journal of Public Health
|March 1, 1993
Summary
Many patients use emergency departments due to primary care access barriers. Referring them to primary care appointments could be a viable solution if services are improved for low-income populations.
Area of Science:
- Health Services Research
- Public Health Policy
Background:
- Emergency departments (EDs) are often used for non-emergent conditions.
- Access barriers to primary care contribute to ED overuse.
Purpose of the Study:
- To assess the clinical appropriateness and patient acceptability of referring non-emergent ED patients to primary care.
- To compare ED use patterns between patients with and without a regular source of care.
Main Methods:
- Study of 700 patients awaiting care in a public hospital ED.
- Measurement of access to alternative care, clinical appropriateness of ED use, and patient willingness to use primary care.
- Comparison between patients with and without a regular source of care.
Main Results:
- 45% of patients cited primary care access barriers for ED use.
- Only 13% of ED visits were clinically appropriate for emergency services.
- Patients with regular care sources used EDs more appropriately.
- 38% of patients were willing to accept a primary care appointment within 3 days.
Conclusions:
- Public EDs could refer a significant number of patients to primary care.
- Successful referral requires enhanced availability and coordination of primary care services.
- Improvements are crucial for low-income populations to make this alternative viable.