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. 2012 Nov;13(5):410-5.
doi: 10.5811/westjem.2011.11.6820.

Factors influencing emergency department preference for access to healthcare

Lindsay E Brown  1 , Ryan Burton, Brian Hixon, Manasi Kakade, Parul Bhagalia, Catherine Vick, Andrew Edwards, Mary T Hawn
Affiliations

Factors influencing emergency department preference for access to healthcare

Lindsay E Brown et al. West J Emerg Med. 2012 Nov.

Abstract

Introduction: African-Americans are more likely than Caucasians to access healthcare through the emergency department (ED); however, the reasons behind this pattern are unclear. The objective is to investigate the effect of race, insurance, socioeconomic status, and perceived health on the preference for ED use.

Methods: This is a prospective study at a tertiary care ED from June to July 2009. Patients were surveyed to capture demographics, healthcare utilization, and baseline health status. The primary outcome of interest was patient-reported routine place of healthcare. Other outcomes included frequency of ED visits in the previous 6 months, barriers to primary care and patient perception of health using select questions from the Medical Outcomes Study Short Form 36 (SF-36).

Results: Two hundred and ninety-two patients completed the survey of whom 58% were African-American and 44% were uninsured. African-Americans were equally likely to report 3 or more visits to the ED, but more likely to state a preference for the ED for their usual place of care (24% vs. 13%, p < 0.01). No significant differences between groups were found for barriers to primary care, including insurance. African-Americans less often reported comorbidities or hospitalization within the previous 6 months (23% vs. 34%, p = 0.04). On logistic regression modeling, African-Americans were more than 2 times as likely to select the ED as their usual place of healthcare (OR 2.24, 95% CI 1.22 - 4.08).

Conclusion: African-Americans, independent of health insurance, are more likely than Caucasians to designate the ED as their routine place of healthcare.

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Figures

Figure 1.
Figure 1.
Patient-reported usual place of health care by race.
Figure 2.
Figure 2.
Patient-reported usual place of health care by insurance status.
See this image and copyright information in PMC

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