Health Care Quality

Patients who are dissatisfied with their usual source of care may seek costly nonurgent care in the emergency department

Emergency departments (EDs) are a safety net for nonurgent care for patients who do not have a usual source of care (USC). However, patients who are dissatisfied with their USC or have trouble accessing their USC are also more likely to go to the ED for a nonurgent visit, concludes a study supported by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00059). Joshua H. Sarver, B.A., of Case Western Reserve University School of Medicine, and colleagues measured USC satisfaction and access as well as nonurgent ED use at least once during 1996 based on data from AHRQ's 1996 nationally representative Medical Expenditure Panel Survey.

Dissatisfaction with the USC (22 percent of those surveyed) or USC staff (26 percent), lack of confidence in the USC's ability (4 percent), difficulty scheduling an appointment (8 percent), difficulty reaching the USC by phone (9 percent), and waiting more than an hour despite having an appointment (6 percent) were all significantly associated with having a nonurgent ED visit. For example, less than 5 percent of those who were very satisfied and 11 percent of those who were "not at all" satisfied with the quality of their USC had a nonurgent ED visit.

The relationship between USC dissatisfaction and nonurgent ED use persisted even after adjustment for patient age, sex, race, education, health status, employment status, income, insurance, region of residence, and rural versus urban residence. Improving satisfaction with and access to a patient's USC may be a safe and effective alternative to financial disincentives to reduce non-urgent ED use. The researchers suggest that health insurance plans exercise caution in imposing large financial barriers to ED use because this may doubly penalize patients who perceive poor access and quality of care from their USC.

More details are in "Usual source of care and nonurgent emergency department use," by Mr. Sarver, Rita K. Cydulka, M.D., M.S., and David W. Baker, M.D., M.P.H., in the September 2002 Academic Emergency Medicine 9, pp. 916-923.

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