Are Patients' Perceptions Of Acuity And Their Decision To Seek Care In The Emergency Department Affected By Demographic and Socioeconomic Variables and Access to Primary Care?

The recent increase in emergency department (ED) patient volume has been attributed to lack of alternative healthcare access, and patient's “inappropriate” use of the ED. This study determined if demographic and socioeconomic factors, access to primary care affect patient perceptions of acuity and decision to visit the ED.

ED patients that met criteria were surveyed assessing their medical acuity on a 5- point acuity scale, access to primary care and personal and socio-economic variables. Demographic variables were abstracted from electronic medical records (EMR). 

Of the 387 patients surveyed, 60.7% patients were female, 60.3%  African- American, 48.2% single, 32.8% married, 47.4% has public insurance vs 35.3% private insurance, 17.3% uninsured, 56.1% employed or on benefits, 74.4% had primary care physician (PCP), 53.5% were discharged vs 43.2% admitted vs 3.4% transferred. Variables associated with patients’ higher perceived acuity include mode of transportation (ambulance vs. nonambulance) (p< 0.001), access to primary care (access to PCP/clinic vs. no PCP/clinic) (p=0.006), reason for ED visit (concerns about illness/injury vs. no access to other care vs. convenience) (p=0.021), and having a PCP (have PCP vs. no PCP) (p= 0.013). 

Patients’ perceptions of acuity were significantly higher if they arrived by ambulance, had prior access to a PCP or clinic, were concerned for their current illness/injury vs. lack of access or convenience. The predominant reason given by patients for their current and prior ED visits suggest that patients are not inappropriately using the ED for their convenience or lack of access but are worried about their current illness/injury.  

Learning Areas:

Administer health education strategies, interventions and programs
Clinical medicine applied in public health
Program planning
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Discuss how access to primary care and other demographic and socio-economic variables impact patients' perceptions of acuity.

Keyword(s): Decision-Making, Health Care Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am responsible for all preliminary research, methods proposal, materials development, data collection and analysis and result conclusions.
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.

Back to: 3097.0: Emergency Medical Services and Preparedness