142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

309233
Willingness to accept alternatives to traditional emergency care: Patient characteristics, alternate transport modes and alternate destinations

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 1:15 PM - 1:30 PM

Courtney Marie Cora Jones, PhD, MPH , Department of Emergency Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY
Erin B Wasserman , Department of Public Health Sciences, University of Rochester, Rochester, NY
Timmy Li, BA, EMT-B , Department of Public Health Sciences, University of Rochester, School of Medicine and Dentistry, Rochester, NY
Manish N Shah, MD MPH , Department of Emergency Medicine, University of Rochester, Rochester, NY
Background

Emergency departments (EDs) are witnessing increased demand for services and many ED patients can be appropriately treated at alternative destinations, such as urgent care centers (UCCs) and primary care physician (PCP) offices.  However, research on patient willingness to accept such alternatives is limited. 

 Methods

We conducted a cross-sectional survey study among patients at an academic medical center ED. We developed an interview-based survey that included questions on demographic and clinical characteristics, perceived illness severity, and acceptability of alternatives to traditional emergency care for acute illness and injuries.  We calculated the proportion of subjects who found transport modes and alternative destinations acceptable and developed a log-binomial regression model to identify patient characteristics associated with acceptability of alternative destinations.

 Results

There were 1,052 subjects available for analysis. The median age was 61 and 51.4% were female.  65% of subjects indicated transportation via medical transport van as acceptable and 69% indicated treatment at an UCC or PCP office was acceptable.  In multivariable analysis, age, race, clinical acuity, and patient-perceived illness severity were statistically significant predictors of willingness to accept alternatives to ED-based care (p<0.05). 

 Conclusion

The majority of subjects found alternative transport modes and alternative destinations to be acceptable and person-specific characteristics can be used to identify which patients may be willing to be treated at non-ED locations.  Before widespread alternative destination programs can be implemented, further research should confirm these findings in other samples and identify which patients can be safely treated using these alternative care delivery options.

Learning Areas:

Clinical medicine applied in public health
Other professions or practice related to public health
Public health or related research

Learning Objectives:
Explain why alternatives to emergency care may benefit patients as well as the broader emergency care system. Discuss which alternatives to traditional emergency care were most acceptable to subjects in this sample. Identify patient-level factors associated with increased acceptability of alternatives to emergency department care.

Keyword(s): Emergency Medical Services, Health Care Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I'm an Assistant Professor of Emergency Medicine and Public Health Sciences, with extensive experience conducting public health research. I have 7 years of experience in the field of emergency medicine research. Specifically, my research foci include prehospital ambulance-based emergency medical services (EMS) and how patient care delivered in this unique setting can influence patient outcomes and the efficiency of the overall emergency care system.
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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