197304 Emergency room use among working age adults with chronic health care needs: A problem of access

Monday, November 9, 2009: 4:50 PM

Elizabeth K. Rasch, PT, PhD , Clinical Research Center, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD
Stephen Gulley, PhD, MSW , Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, Bethesda, MD
Leighton Chan, MD, MPH , Clinical Research Center, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD
     
The IOM recently released a report suggesting that hospital visits for certain conditions were avoidable and that lack of access to outpatient care may be one factor contributing to hospitalizations. A similar argument may apply to emergency room (ER) use and may be especially true for individuals known to have difficulty accessing the health care system, such as adults with disabilities and chronic conditions. In order to better understand these issues among working age Americans (18-64 years of age) we examined access to care and ER use among nationally representative groups of adults with and without chronic health care needs. Adults with chronic health care needs (ACHCN) included three subgroups, all of whom had at least one chronic condition: those without self-reported limitations, those reporting non-ADL/IADL limitations, and those reporting ADL/IADL limitations. Logistic regression models were applied to pooled annual data from the 2002-2004 Medical Expenditure Panel Survey to examine relationships between any ER use and access to medical care and prescription medications. After controlling for socio-demographic factors, resources, and number of acute conditions, lack of or delayed access to medical care and prescription medications were significantly related to ER use. In addition, more adults with limitations reported difficulty accessing necessary medical care and prescription medications (17%, 14% respectively) compared to ACHCN without limitations (7%, 5%) or adults without chronic health care needs (3%, 1%). This suggests the need for improved access to and coordination of primary care for adults with chronic health care needs, especially those with limitations.

Learning Objectives:
At the conclusion of the session, the participant will be able to: 1) describe emergency room (ER) use among working age adults with and without chronic health care needs, including those with limitations; 2) describe the extent of unmet need for and delayed receipt of medical services and prescription medications among adults with and without chronic health care needs; 3) describe the possible effects of these access problems on adults with chronic health care needs, with a focus on ER use; 4) identify the importance of these findings for public health.

Keywords: Disability, Access to Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a BS and MS degree in Physical Therapy and a PhD in Rehabilitation Science with a concentration in Epidemiology. I have published over 20 peer reviewed manuscripts, all of which are relevant to persons with disabilities and many of which focus on the health of and health care for people with disabilities. I have presented research specifically on the health of people with disabilities at 5 major scientific conferences in the last few years. In the last few years, I have been an invited speaker at the Virginia Department of Health, the University of Washington, and the University of Maryland, School of Medicine on disability related topics.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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