Access to Care and Depression among Emergency Department Patients

Abstract

Background The prevalence of depression among patients in the emergency department (ED) is significantly higher than in the general population, making the ED a potentially important forum for the identification of depression and intervention. Concomitant to the identification of depression is the issue of patient access to appropriate care. Objectives This study sought to establish prevalence estimates of potential barriers to care among ED patients and relate these barriers with symptoms of depression. Methods Two medical students conducted brief surveys on all ED patients ≥ 18 years on demographics, perceived access to care, and depression. Results A total of 636 participants were enrolled. The percentage of participants with mild or greater depression was 42%. The majority of patients reported experiencing some barriers to care, with the most prominent being difficulty finding transportation, work responsibilities, and the feeling that the doctor is not responsive to their concerns. Higher depression scores were bivariately associated with higher overall barriers to care mean scores (r=0.44, p<0.001), suggesting that greater symptoms of depression are associated with greater difficulties accessing care. Particularly strong associations were observed between symptoms of depression and difficulty finding transportation, the feeling that the doctor is not responsive to patients’ concerns, embarrassment about a potential illness and confusion trying to schedule an appointment. Conclusion Across all barriers analyzed, there was a greater incidence of depression associated with a greater perception of barriers. These barriers may be used as potential targets for intervention to increase access to health care resources.

Depression Linked to Frequent Emergency Department Use in Large 10-year Retrospective Analysis of an Integrated Health Care System

“…Although the concept of psychosomatic medicine is far from new, we wish to highlight the importance of considering psychiatric factors in improving health care utilization and outcomes. In many cases, patients may be exhibiting somatic manifestations of depression or may be experiencing exacerbation of medical conditions due to a psychiatric illness that is not optimally controlled [6,14,15,18]. Our findings are consistent with previous reports in showing that depression-associated ED use is often seen in the form of various types of chronic pain [3,12,19].…”

“…The provision of prescription assistance can help address socioeconomic factors known to increase ED usage [42]. Depression symptom severity correlates with increased barriers to health care access, which contributes to increased rates of ED use [18]. Identification of these barriers and enhanced case management may allow for significant improvements in ongoing treatment, critical to reducing the burden of frequent revisits to the ED.…”

Depression and Anxiety Among Emergency Department Patients: Utilization and Barriers to Care

“…The most notable perceived barriers to care were transportation and payment difficulties, as well as fear that the doctor will discover another serious illness. Similar barriers among ED patients have been previously observed . Patients with mental health concerns were particularly likely to report difficulties accessing care, with barriers most pronounced among patients who were both anxious and depressed.…”

“…Anxiety was screened for using the Generalized Anxiety Disorder 7 (GAD‐7), which uses the same time reference and response scale at the PHQ‐9. Items are summed, with scores ≥ 15 indicating “severe anxiety.” Each of these measures has been previously used in the ED …”

“…Parallel service providers, like medical students or volunteers, represent resources for addressing the issues of identification and intervention upon nonemergent but urgent concerns such as depression and anxiety with very little impact on clinical flow . These types of individuals can effectively administer mental health and access to care surveys with fidelity and provide reports to both patients and providers that can improve care …”