title: Regular source of ambulatory care and medical care utilization by patients presenting to a public hospital emergency department.
abstract: OBJECTIVE
  To determine the regular source of care and the relationship between usual provider and use of medical services among ambulatory emergency department patients.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  A public hospital in Los Angeles County, California.
  
  
  METHODS
  A total of 1190 stable, ambulatory adults presenting to the emergency department during a 2-week period.
  
  
  METHODS
  Self-reported regular source of care, usual health status, and recent physician visits.
  
  
  RESULTS
  A total of 16% of the patients identified an emergency department as their regular source of care. One fourth of this group reported fair or poor health. African Americans and Latinos were more likely than whites to identify an emergency department as their regular source of care. Patients who identified an emergency department as their regular source of care had 25% fewer physician visits and were less likely to have seen a physician during the preceding 3 months than patients who were usually seen in an office or clinic (relative risk, 0.45; 95% confidence interval, 0.28 to 0.70). Of all patients, 56% identified a regular source of care other than an emergency department, but 24% to 36% of all their recent physician visits still occurred in an emergency department.
  
  
  CONCLUSIONS
  Our patients rely heavily on emergency departments for ambulatory physician visits, regardless of their reported regular source of care. However, patients who identify an emergency department as their regular source of ambulatory care used physician services less frequently than patients with access to providers in other settings. These issues require further evaluation with population-based surveys.
authors.affiliation: Division of General Internal Medicine, Harbor-UCLA Medical Center, Torrance 90509.
authors.forename: D W
authors.initials: DW
authors.lastname: Baker
authors.forename: C D
authors.initials: CD
authors.lastname: Stevens
authors.forename: R H
authors.initials: RH
authors.lastname: Brook
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D003710:Demography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006746:Hospital Bed Capacity, 500 and over; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D015141:Los Angeles; D008297:Male; D012959:Socioeconomic Factors