Primary Care

Having an ongoing relationship with a doctor greatly reduces ER visits by elderly patients

Many emergency department (ED) visits by the elderly can be avoided by having an ongoing relationship with a doctor, concludes a study supported in part by the Agency for Healthcare Research and Quality (Rural Health Research Center contract 290-93-0136). In general, elderly patients with more severe illness are more apt than patients who are not as sick to visit the ED. However, regardless of age and illness severity, elderly Medicare patients in this study who had a regular doctor-patient relationship were about half as likely to visit the ED as those who did not have a principal-care doctor (a doctor who saw the patient for the majority of clinical visits). This was true whether the principal-care doctor was a primary care physician or a specialist.

First author Roger A. Rosenblatt, M.D., M.P.H., of the University of Washington School of Medicine, principal investigator Laura-Mae Baldwin, M.D., M.P.H., of the University's Rural Health Research Center, and colleagues studied ED use by Medicare patients in Washington State who were older than 65 years in 1994 and not members of a health maintenance organization. A total of 18 percent of patients had one or more ED visits during the year, with the oldest and sickest having more visits. However, those with a generalist principal-care physician had half the odds (odds ratio, OR, 0.47) and those with a specialist principal-care physician had about half the likelihood (OR, 0.58) of visiting the ED of those without such relationships. Even the sickest patients had 31 percent fewer ED visits if they had a principal-care doctor, after controlling for patient case mix, Medicaid eligibility, and rural/urban residence.

An ongoing doctor-patient relationship allows many problems to be discovered and addressed before they reach a point of urgency, and it improves access to doctors in their usual office settings. This study suggests that in disrupting a sustained relationship between a patient and doctor—which often happens when patients change health plans—something of value is destroyed. Increased ED use can be an indicator of that disruption, concludes Dr. Rosenblatt.

For more details, see "The effect of the doctor-patient relationship on emergency department use among the elderly," by Dr. Rosenblatt, George E. Wright, Ph.D., Dr. Baldwin, and others, in the January 2000 American Journal of Public Health 90, pp. 97-102.

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