Referral of medically uninsured emergency department patients to primary care.
OBJECTIVE
To examine the impact primary care referral has on subsequent emergency department (ED) utilization.


METHODS
Uninsured ED patients who reported not having a primary care (PC) provider were referred to PC services at a community health center (CHC). The number of CHC visits completed was documented and the utilization rates of hospital-based services (i.e., ED visits, outpatient clinic visits, and admissions) were compared for patients who completed a CHC visit and those who did not before and after referral.


RESULTS
Of the 655 referred patients, 22% completed at least one CHC visit. Patients who completed a visit were more likely to be older, to be female, and to have a chronic medical problem (p = 0.001). The number of visits to the CHC was significantly related to the payment method. Only 19% of those who were self-pay completed three or more CHC visits, compared with 63% of those who qualified for a sliding fee or insurance (p < 0.001). There was no significant difference in pre- or post-ED utilization between those who completed a CHC visit and those who did not. The only significant difference in utilization between the two study groups was for subsequent outpatient visits. Patients who completed a CHC visit were more likely to receive outpatient specialty care (23%) compared with patients who did not (12%) (p = 0.001).


CONCLUSIONS
For uninsured patients with no regular health care provider, improving access to primary care services is not enough to reduce their visits to the ED.
McCarthy
Melissa Lee
ML
Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD 21205, USA. mmccarth@jhmi.edu
Hirshon
Jon Mark
JM
Ruggles
Rebecca L
RL
Docimo
Anne Boland
AB
Welinsky
Melvin
M
Bessman
Edward S
ES
D003153:Community Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D017064:Process Assessment, Health Care; D015397:Program Evaluation; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data*