Factors Influencing Emergency Department Preference for Access to Healthcare

Abstract

Introduction:African-Americans are more likely than Caucasians to access healthcare through the emergency department (ED); however, the reasons behind this pattern are unclear. The objective is to investigate the effect of race, insurance, socioeconomic status, and perceived health on the preference for ED use.Methods:This is a prospective study at a tertiary care ED from June to July 2009. Patients were surveyed to capture demographics, healthcare utilization, and baseline health status. The primary outcome of interest was patient-reported routine place of healthcare. Other outcomes included frequency of ED visits in the previous 6 months, barriers to primary care and patient perception of health using select questions from the Medical Outcomes Study Short Form 36 (SF-36).Results:Two hundred and ninety-two patients completed the survey of whom 58% were African-American and 44% were uninsured. African-Americans were equally likely to report 3 or more visits to the ED, but more likely to state a preference for the ED for their usual place of care (24% vs. 13%, p < 0.01). No significant differences between groups were found for barriers to primary care, including insurance. African-Americans less often reported comorbidities or hospitalization within the previous 6 months (23% vs. 34%, p = 0.04). On logistic regression modeling, African-Americans were more than 2 times as likely to select the ED as their usual place of healthcare (OR 2.24, 95% CI 1.22 – 4.08).Conclusion:African-Americans, independent of health insurance, are more likely than Caucasians to designate the ED as their routine place of healthcare.

Persistently Frequent Emergency Department Utilization Among Persons With Systemic Lupus Erythematosus

“…Studies have identified poor social support and communication with providers, limitation of financial and transportation resources, reliance on opioids, and lack of belief in and inadequacy of pain control as barriers to multimodality pain management . For these reasons and because of findings showing that regardless of access to care, some patients continue to preferentially utilize the ED for ambulatory care–sensitive conditions (such as chronic pain ), ED‐based interventions for chronic pain management (such as case management, use of chronic pain protocols, and pain specialist consultation in the ED) should be developed to complement outpatient services. Some studies have explored the use of individualized home pain management programs and community health workers who provide social support, navigation of health systems and resources, and counseling, for the management of chronic pain in sickle cell disease .…”

Does Diversity Matter for Health? Experimental Evidence from Oakland

“…Subjects who experienced high congestion (greater than nine people in the waiting room, the fiftieth percentile) or those who were recruited from farther away locations (longer than 18 minutes by car, the fiftieth percentile) also elected to receive more services when randomized to a black doctor than a non-black doctor. 14 African Americans visit the emergency room more often than non-Hispanic whites, which some have linked to lack of insurance, lower socioeconomic status, and mistrust that precludes health care utilization until an advanced stage of illness (Arnett et al 2016, Brown et al 2012. Panel C demonstrates that those who use the emergency room more often increased their demand for services when randomized to a black doctor.…”

What is the key to culturally competent care: Reducing bias or cultural tailoring?

“…For example, in comparison to European American patients, African American patients see themselves as being in worse health and receiving lower quality of care (Smedley et al, 2003). They are more likely to visit the emergency department and they have fewer physician visits per year (Brown et al, 2012; Smedley et al, 2003). In the clinician’s office, for example, physicians are more verbally dominant and engage in less patient-centered communication with African American patients than with White patients (Johnson, Roter, Powe, & Cooper, 2004).…”