Abstract | April 10, 2023

Lack of Primary Care Physician Coverage and Over-representation of Black Patients and Non-Native English Speakers in Preventable Emergency Department Visits

Leo Meller, BS

Co-authors:Leo Meller, BS, Medical Student, MS1, UC San Diego SOM, La Jolla, CA; Chika Okeke, BS, Medical Student, MS3, UC Irvine SOM, Irvine, CA; Christian Makar, BS, Medical Student, MS3, UC Irvine SOM, Irvine, CA; Arham Aijaz, Research Associate, UC Irvine, Irvine, CA; Feben Messele, BS, Medical Student, MS3, UC Irvine SOM, Irvine, CA; Meron Gebreyes, BS, Medical Student, MS3, UC Irvine SOM, Irvine, CA; Kaveri Curlin, BS, Medical Student, MS2, UC Irvine SOM, Irvine, CA; Candice Taylor-Lucas, MD, MPH, Pediatrician, UC Irvine Health, Irvine, CA; Soheil Saadat, MD, PhD, MPH, Faculty of Research, Emergency Medicine, UC Irvine Health, Irvine, CA.

Learning Objectives

  1. 1. Identify the patient populations over-represented in preventable emergency department visits
  2. 2. Describe the risk factors associated with preventable emergency department visits.
  3. 3. Discuss the negative consequences of preventable emergency department visits.

Background:

Non-urgent use of the emergency department (ED) is costly for patients. It can lead to increased healthcare spending and ED overcrowding and negatively affect primary care physician (PCP)-patient relationships. We aim to evaluate the association between perceived medical urgency, PCP coverage (whether a patient has a PCP), and patient descriptive characteristics with utilization of the ED for non-urgent clinical care.

Methods:

In this cross-sectional study, adult ED patients were stratified to preventable and non-preventable ED visits according to their emergency severity index (ESI) at an urban, academic ED. A REDCap questionnaire was used to assess descriptive information, self-perceived medical urgency, and PCP Coverage. Chi-Square tests at a 5% significance level were performed to examine differences between race, native language, self-perceived medical urgency, and PCP coverage between preventable and non-preventable ED visits.

Results:

Study participants included 348 adult patients (52% female), of which 160 (46%) were preventable visits (ESI 4-5). There were more preventable visits among Black patients compared to non-Black patients (69.6% vs 30.4%, p=0.028) and the preventable group had less native English speakers than the non-preventable group (38.8% vs 61.2%, p=0.035). Compared to patients in the non-preventable ED visit group, patients in the preventable group are more likely to agree that they could have been seen and treated effectively by a PCP (p=0.003). Fewer patients in the preventable group have a PCP that they can see regularly and make an appointment with compared to the non-preventable group (40.3% vs 59.7%, p=0.004).

Conclusions:

Our results indicate that Black patients and non-native English speakers were overrepresented in

preventable ED visits compared to their counterparts, suggesting these patients may be more vulnerable to the plethora of negative consequences associated with utilizing the ED for non-emergent medical services. In addition, our study also revealed that patients in the preventable ED visit group were less likely to have a PCP, even though they were more likely to agree that a PCP could manage their symptoms. Future interventions are needed to address this lack of PCP coverage among preventable ED patients to reduce patient financial burden, ED overcrowding, and overall healthcare spending.



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