Nonurgent emergency department visits: the effect of having a regular doctor.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Health Services Research and Development, Brockton/West Roxbury VA Medical Center, MA, USA.
L A
LA
Petersen
H R
HR
Burstin
A C
AC
O'Neil
E J
EJ
Orav
T A
TA
Brennan
D000328:Adult; D000368:Aged; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009511:New England; D016017:Odds Ratio; D010821:Physicians, Family / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors