Dependence on Emergency Care among Young Adults in the United States

Fortuna, Robert J.; Robbins, Brett; Mani, Nandini; Halterman, Jill S.

doi:10.1007/s11606-010-1313-1

Cited by 93 publications

(70 citation statements)

References 20 publications

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“…18,19 Furthermore, the results also indicate that younger patients may be more likely to rely on the ED for their health care than do older patients, which is a phenomenon that an earlier study has suggested. 20 This phenomenon may be a result of younger patients' unmet needs owing to insufficient health insurance coverage or inexperience in navigating through the health care system.…”

Section: Original Research and Contributionsmentioning

confidence: 99%

Patterns of Multiple Emergency Department Visits: Do Primary Care Physicians Matter?

Maeng

Hao

Bulger

2017

TPJ

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Context: Overutilization and overreliance on Emergency Departments (EDs) as a usual source of care can lead to unnecessarily high costs and undesirable consequences, such as a gap in care coordination and inadequate provision of preventive care.Objective: To identify factors associated with multiple ED visits by patients, in particular, the impact of primary care physicians (PCPs) on their patients' multiple ED visit rates.Design: Geisinger Health Plan claims data among adult patients who averaged more than 1 ED visit within a 12-month period between 2013 and 2014 were obtained (N = 20,351).Main Outcome Measures: Rate of ED visits. Three linear regression models using patient characteristics and utilization patterns as covariates along with PCP fixed effects were estimated to explain the variation in the multiple ED visit rates.Results: Multiple ED visits were significantly associated with younger age (18-39 years), having Medicaid insurance, and greater comorbidity. Higher rates of physician office visits and inpatient admissions were also associated with higher rates of multiple ED visits. Accounting for PCP characteristics only marginally improved the explained variation (R 2 increased from 0.14 to 0.16).Conclusions: Multiple ED visit patterns are likely driven by patients' health conditions and care needs rather than by their PCPs. Multiple ED visits also appear to be complementary, rather than substitutionary, to PCP visits, suggesting that PCP-focused interventions aimed at reducing ED use are unlikely to have a major impact.

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Section: Original Research and Contributionsmentioning

confidence: 99%

Patterns of Multiple Emergency Department Visits: Do Primary Care Physicians Matter?

Maeng

Hao

Bulger

2017

TPJ

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“…We evaluated adolescents between 15 and 19 years of age and defined young adults as those between 20 and 29 years of age on the basis of previous studies. 22,23 …”

Section: Study Time Period and Age Groupsmentioning

confidence: 99%

Prescribing of Controlled Medications to Adolescents and Young Adults in the United States

et al. 2010

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WHAT'S KNOWN ON THIS SUBJECT:The nonmedical use of prescription drugs by adolescents and young adults has surpassed all illicit drugs except marijuana and has become an increasing public health concern. Adolescents and young adults are in the most likely age groups to abuse prescription medications. WHAT THIS STUDY ADDS: OBJECTIVE:The nonmedical use of prescription drugs by adolescents and young adults has surpassed all illicit drugs except marijuana, yet little is known about prescribing patterns. We examined the prescribing of controlled medications to adolescents aged 15 to 19 and young adults aged 20 to 29. METHODS:We used cross-sectional data from the National Ambulatory Medical Care Survey (N ϭ 4304 physicians) and the National Hospital Ambulatory Medical Care Survey (N ϭ 2805 clinics; N ϭ 1051 emergency departments) between 2005 and 2007. We also used consecutive data from 1994 to describe trends. RESULTS:A controlled medication was prescribed at 2.3 million visits by adolescents and 7.8 million visits by young adults in 2007. Between 1994 and 2007, controlled medications were prescribed at an increasing proportion of visits from adolescents (6.4%-11.2%) and young adults (8.3%-16.1%) (P Ͻ .001 for trend). This increase was seen among males and females, in ambulatory offices and emergency departments, and for injury-related and non-injury-related visits (all P Ͻ .001). A controlled medication was prescribed during 9.6% of all adolescent visits and 13.8% of young-adult visits for non-injury-related indications and at 14.5% of adolescent visits and 27.0% of young-adult visits for injury-related reasons. Controlled medications were prescribed at a substantial proportion of visits for common conditions, such as back pain, to both adolescents (23.4%) and young adults (36.9%). CONCLUSIONS:Controlled medications are prescribed at a considerable proportion of visits from adolescents and young adults, and prescribing rates have nearly doubled since 1994. This trend and its relationship to misuse of medications warrants further study. Pediatrics

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“…Young adults have traditionally been less integrated into the healthcare system, as they are more likely to be uninsured and less likely to have a usual source of care. [7][8][9] Provider specialty and both provider and patient perceptions of risk based on patient age, gender, race/ethnicity, or comorbidities may impact awareness and treatment as well. A recent study of adults with regularly scheduled physician visits who met clinical criteria for hypertension found that those who were ages 18-24 years vs. at least 60 years of age were 28 % less likely to have their hypertension diagnosed by their physician.…”

Section: Introductionmentioning

confidence: 99%

Hypertension Awareness and Control Among Young Adults in the National Longitudinal Study of Adolescent Health

et al. 2014

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BACKGROUND: Young adults are less likely than older adults to be aware they have hypertension or to be treated for hypertension. OBJECTIVE: To describe rates of hypertension awareness and control in a cohort of young adults and understand the impact of health insurance, utilization of preventive care, and self-perception of health on rates of hypertension awareness and control in this age group. DESIGN AND PARTICIPANTS: Cross-sectional study of 13,512 young adults participating in Wave IV of the National Longitudinal Study of Adolescent Health in 2007-2008. MAIN MEASURES: We defined hypertension as an average of two measured systolic blood pressures (SBP) ≥ 140 mmHg, diastolic blood pressures (DBP) ≥ 90 mmHg, or self-report of hypertension. We defined hypertension awareness as reporting having been told by a health care provider that one had high blood pressure, and assessed awareness among those with uncontrolled hypertension. We considered those aware of having hypertension controlled if their average measured SBP was < 140 mmHg and DBP was < 90 mmHg. KEY RESULTS: Of the 3,303 young adults with hypertension, 2,531 (76 %) were uncontrolled, and 1,893 (75 %) of those with uncontrolled hypertension were unaware they had hypertension. After adjustment for age, sex, race/ethnicity, weight status, income, education, alcohol and tobacco use, young adults with uncontrolled hypertension who had (vs. didn't have) routine preventive care in the past 2 years were 2.4 times more likely (95 % confidence interval [CI] 1.68-3.55) to be aware, but young adults who believed they were in excellent (vs. less than excellent) health were 64 % less likely to be aware they had hypertension (OR 0.36,. Neither preventive care utilization nor self-rated health was associated with blood pressure control. CONCLUSIONS:In this nationally representative group of young adults, rates of hypertension awareness and control were low. Efforts to increase detection of hypertension must address young adults' access to preventive care and perception of their need for care.KEY WORDS: hypertension; young adult; health services accessibility; health status.

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Dependence on Emergency Care among Young Adults in the United States

Cited by 93 publications

References 20 publications

Patterns of Multiple Emergency Department Visits: Do Primary Care Physicians Matter?

Patterns of Multiple Emergency Department Visits: Do Primary Care Physicians Matter?

Prescribing of Controlled Medications to Adolescents and Young Adults in the United States

Hypertension Awareness and Control Among Young Adults in the National Longitudinal Study of Adolescent Health

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