Nonurgent Emergency Department Visits

TLDR

The study evaluates whether having a regular primary‑care physician reduces the likelihood of nonurgent emergency department visits, adjusting for sociodemographic and health factors. A cross‑sectional survey of 1,696 adults presenting with chest pain, abdominal pain, or asthma at five urban teaching hospitals collected demographic, health, and primary‑care relationship data, and chart review determined visit urgency. Patients without a regular physician were 1.6 times more likely to make nonurgent ED visits, independent of age, gender, marital status, health status, and comorbidities, while race, insurance, and education had no effect; thus a primary‑care relationship appears to curb nonurgent ED use.

Abstract

The authors assess the association between having a regular doctor and presentation for nonurgent versus urgent emergency department visits while controlling for potential confounders such as sociodemographics, health status, and comorbidity.A cross-sectional study was conducted in emergency departments of five urban teaching hospitals in the northeast. Adult patients presenting with chest pain, abdominal pain, or asthma (n = 1696; 88% of eligible) were studied. Patients completed a survey on presentation, reporting sociodemographics, health status, comorbid diseases, and relationship with a regular doctor. Urgency on presentation was assessed by chart review using explicit criteria.Of the 1,696 study participants, 852 (50%) presented with nonurgent complaints. In logistic regression analyses, absence of a relationship with a regular physician was an independent correlate of presentation for a nonurgent emergency department visit (odds ratio 1.6; 95% confidence interval 1.2, 2.2) when controlling for age, gender, marital status, health status, and comorbid diseases. Race, lack of insurance, and education were not associated with nonurgent use.Absence of a relationship with a regular doctor was correlated with use of the emergency department for selected nonurgent conditions when controlling for important potential confounders. Our study suggests that maintaining a relationship with a regular physician may reduce nonurgent use of the emergency department regardless of insurance status or health status.