Factors Influencing Emergency Department Preference for Access to Healthcare

Abstract

Introduction: African-Americans are more likely than Caucasians to access healthcare through theemergency department (ED); however, the reasons behind this pattern are unclear. The objectiveis to investigate the effect of race, insurance, socioeconomic status, and perceived health on thepreference for ED use.Methods: This is a prospective study at a tertiary care ED from June to July 2009. Patients weresurveyed to capture demographics, healthcare utilization, and baseline health status. The primaryoutcome of interest was patient-reported routine place of healthcare. Other outcomes includedfrequency of ED visits in the previous 6 months, barriers to primary care and patient perception ofhealth 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 visitsto 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 withinthe previous 6 months (23% vs. 34%, p = 0.04). On logistic regression modeling, African-Americanswere 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 Caucasiansto designate the ED as their routine place of healthcare.

Keywords

• emergency medicine
• emergency department
• clinical practice
• access
• health care