The emergency rooms of America are increasingly serving as backup for acute-care doctors.
While general practitioners historically were the first point of contact for acute care, that's less the case now. Only 42 percent of the acute care visits are to patients' personal physicians, according to a recently published article in the journal Health Affairs. As an alternative, acute care patients visit ERs (28 percent), specialists (20 percent) or outpatient departments (7 percent).
"More and more patients regard the emergency department as an acceptable or even the proper place to go when they get sick, and the reality is that the ER is frequently the only option," said lead study author Stephen R. Pitts, an associate professor of medicine in the Department of Emergency Medicine at Emory University School of Medicine. He added that primary-care doctors' packed schedules and limited office hours mean all too often, patients can't get the care they need, when they need it, from their family doctor.
A disconnect between supply and demand becomes apparent when one compares the share of doctors ED physicians constitute with the share of acute care visits they handle. Less than 5 percent of doctors are emergency physicians, but they handle one-quarter of all acute care visits, and most visits by uninsured patients.
The authors of the study seem pessimistic about whether the system will become more efficient. "If primary care capacity lags behind rising demand, patients will seek care elsewhere," they write. "If reimbursement rates are too low to interest office-based physicians in treating patients with public insurance, such patients may have no choice but to head to the nearest emergency department."
Researchers analyzed 354 million annual visits for acute care from 2001 to 2004, using three federal surveys of ambulatory care delivery from the National Center for Health Statistics.
In other findings, two-thirds of acute care visits to emergency departments took place on weekends or on a weekday after office hours. Stomach and chest pain were the most frequent acute care problems treated by emergency departments, while primary-care doctors most often saw coughs, sore throats and skin rashes.
To learn more:
- read the abstract of the Health Affairs article on where American get acute care
- read the press release on the studies
HHS report: ED visits rise 23 percent over decade
HHS: One-fifth of ED visits are by uninsured patients
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