title: Discontinuity of care: urgent care utilization within a health maintenance organization.
abstract: OBJECTIVE
  To determine the demographic characteristics, attitudes, and perceived barriers to primary care reported by patients seen in the urgent care department of a health maintenance organization (HMO) health center.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Patients aged 18 years or older who sought care at the urgent care department of a large, urban health center of a staff-model HMO were eligible for the study. Patients were handed a survey as they registered in the urgent care department. Demographic and visit diagnoses data were obtained through review of the computerized medical record.
  
  
  RESULTS
  Patients seeking treatment at the urgent care department were significantly younger than those seen at a primary care physician's office (mean age, 40 years versus 46 years; P < or = 0.0001) but otherwise had similar demographic characteristics. Nearly 90% of 421 patients seen in the urgent care department reported having a primary care physician. When asked to list the reasons why they came to the urgent care department instead of the primary care offices, 64% said they needed to be seen immediately, 47% came because the primary care offices were closed, 27% cited the constraints of work or childcare, and 25% said they were unable to get an appointment with their primary care physician. Almost half of patients (47%) said they would have preferred to see their primary care physician within a day or two rather than seeking care at the urgent care department.
  
  
  CONCLUSIONS
  Patients treated in the urgent care department reported various barriers to seeing their primary care physician. Improving same-day access to primary care providers will help alleviate this problem and may increase patient satisfaction.
authors.affiliation: Harvard Pilgrim Health Care and Harvard Medical School, Boston, MA 02215, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Plauth
authors.forename: S D
authors.initials: SD
authors.lastname: Pearson
mesh_terms: D000208:Acute Disease; D000328:Adult; D001900:Boston; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D003625:Data Collection; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006279:Health Maintenance Organizations / Q000458:organization & administration* / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data