ED community partnership: Barriers to accessing primary care in appropriate settings

This study reports findings from a survey of patients who use hospital emergency departments for primary care needs on their reported barriers to accessing primary care services in appropriate community settings. The study was part of a CMS-funded demonstration project that pilot-tested a model in two sites (each a partnership of an ED and FQHC) to identify patients with primary care needs in EDs and provide express care; refer them to the FQHC for follow-up; and provide care coordination, intensive case management and patient education/support services to ensure their future use of appropriate/cost-effective sites. Project patients, identified during ED triage, were surveyed and data was collected on their reasons for inappropriate ED use. Separate surveys were completed for each patient first and repeat visits. Identified barriers were addressed on an ongoing basis, including: providing transportation; tracking and reminding patients about follow-up appointments; ensuring timely access to services that are culturally and linguistically appropriate and that meet the individual needs of diverse patients; linking with intensive chronic disease management programs; and ultimately helping patients find more accessible permanent medical homes. Approximately 6,000 surveys were completed for patients' initial visits and 1,000 for repeat visits. The most frequently reported barriers for inappropriate ED use in both surveys were reasons such as “felt I needed emergency services” and “doctor's office was closed.” Association of patients' barriers with additional patient information, including their demographics characteristics, type of health conditions, health issues and source of health coverage are also examined and discussed in the report.