Adolescents Who Use the Emergency Department as Their Usual Source of Care

TLDR

Adolescents who rely on the ED as their sole source of care often have unmet mental or physical needs and are likely to miss necessary care. This study examines factors linked to adolescents using the ED as their only health‑care source and proposes that connecting EDs with other services could help at‑risk youth find more appropriate primary care. Using the 1997 Commonwealth Fund Survey of 6,748 in‑school adolescents, the authors applied chi‑square and logistic regression analyses with SUDAAN and found that 4.6% reported the ED as their usual source of care. Factors associated with ED use included male sex, African American ethnicity, low income, rural residence, higher risky behaviors, abuse history, and higher depression scores, and these youths were less likely to have regular well visits and more likely to miss needed care.

Abstract

To examine the factors associated with use of the emergency department (ED) as the only source of health care among adolescents.Analyses of the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls, a nationally representative sample of 6748 in-school male and female adolescents in 5th through 12th grade. The X2 statistics and logistic regression analyses were computed with the use of SUDAAN.Overall, 4.6% of the adolescents in the survey, or 1.5 million adolescents in the United States, reported that the ED was their usual source of health care. In multivariate models, factors associated with the use of the ED included male sex, African American ethnicity, fewer financial resources, and living in a rural area. Adolescents with higher levels of risky behaviors, a history of physical or sexual abuse, and higher depression scores were all more likely to use the ED as their usual source of care. Adolescents who reported using the ED as their usual care source were also less likely to have had regular well visits and were more likely to report having missed needed care than those with other sources of primary care.Adolescents who use the ED as their usual source of care are often from vulnerable populations. Many have special mental or physical needs that are unlikely to be met with ED visits only, and they are likely to have missed care they needed. Creating linkages between EDs and other services could help at-risk adolescents identify and use more appropriate sources of primary care.