Usual source of care and nonurgent emergency department use.
OBJECTIVE
To examine whether dissatisfaction with one's usual source of care (USC) and perceived access difficulties to one's USC were associated with nonurgent emergency department (ED) use.


METHODS
Variables that measured USC satisfaction and access were identified in the 1996 cohort of the Medical Expenditure Panel Survey (MEPS), a nationally representative sample administered by the Agency for Healthcare Research and Quality. The main outcome measured was nonurgent ED use at least once during 1996.


RESULTS
A total of 9,146 adults had a USC other than the ED, had at least one contact with the health care system or were unable to get needed care, and had complete data for all the variables in the final model. Dissatisfaction with the USC, dissatisfaction with the USC staff, lack of confidence in the USC's ability, difficulty scheduling an appointment, difficulty reaching the USC by phone, and long waiting times with an appointment were all associated with having a nonurgent ED visit in 1996 (all at p < 0.05). The positive associations between both dissatisfaction and perceived access barriers and nonurgent ED use persisted even in multiple logistic regression that adjusted for age, sex, race, education, health status, employment status, income, insurance, region of residence, and rural vs. urban residence.


CONCLUSIONS
Patients who are dissatisfied with their USC or perceive access barriers to their USC are more likely to have a nonurgent ED visit.
Case Western Reserve University School of Medicine Cleveland, OH, USA. sarver@po.cwru.edu
Joshua H
JH
Sarver
Rita K
RK
Cydulka
David W
DW
Baker
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005163:Factor Analysis, Statistical; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000592:standards*; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D014850:Waiting Lists