title: Access to care among emergency department patients.
abstract: OBJECTIVE
  The number of annual patient visits to US emergency departments (ED) has been increasing since 1995, whereas the number of ED is decreasing. Previous studies have identified many reasons why patients seek care in ED, including lack of access to care elsewhere, lack of insurance, inability to see their doctor in a timely manner and lower levels of social support. This study identifies factors that influence patients' decisions to seek care in ED and assesses their access to primary care.
  
  
  METHODS
  A prospective study, conducted by standardised verbal interview with adult ED patients, was performed in the XXX ED during June-July 2009. Non-English speaking patients, the mentally incapacitated and those under severe distress were excluded. Consenting patients were asked a series of questions on access to primary care, factors that influenced their decision to attend the ED, health insurance status and demographic information.
  
  
  RESULTS
  Among 292 study participants (89% response rate), the majority were over 40 years (52%), Caucasian (69%) and unemployed (58%). Among employed participants, 66% (N=88/133) of employers offered health insurance. Most participants had a primary care physician (PCP; 73%; N=214), but a minority had called their PCP about the current problem (31%; N=78/253). Most participants came to the ED because of convenience/location (41%) or preference for this institution (23%). Participants came to the ED, rather than their regular doctor, because they had no PCP (27%), an emergency condition (19%), or communication challenges (17%).
  
  
  CONCLUSIONS
  Convenience, location, institutional preference and access to other physicians are common factors that influence patients' decisions to seek care in ED.
authors.affiliation: University of Toledo College of Medicine, Toledo, Ohio, USA. catherine.marco@utoledo.edu
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Marco
authors.forename: Mark
authors.initials: M
authors.lastname: Weiner
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Ream
authors.forename: Dan
authors.initials: D
authors.lastname: Lumbrezer
authors.forename: Djuro
authors.initials: D
authors.lastname: Karanovic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004522:Educational Status; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014481:United States; D055815:Young Adult