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Uninsured patients more likely to use emergency department for follow-up care

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Research from Johns Hopkins University has found that providing access to an outpatient clinic is not enough to keep a portion of discharged trauma patients from returning to the emergency department for follow-up care.

The return visits were found to be for needs as minor as pain medication refills and dressing changes, according to a Johns Hopkins University press release.

The study, published the Annals of Emergency Medicine, revealed that patients with Medicaid, Medicare and those with no insurance were 60% more likely to seek such care in the emergency department (ED). Those living in poor neighborhoods were 70% more likely than those with insurance to visit the ED instead of going to a physician’s office or clinic. The findings suggest that many patients who could receive less expensive outpatient care either will not or cannot seek it, the researchers noted.

“Just providing patients access to doctors outside of the ER clearly isn’t working, especially for those without insurance,” study leader Adil H. Haider, MD, MPH, stated in the release. “We need better ways to help patients discharged from the hospital receive appropriate follow-up care.”

Haider and his co-authors used their hospital’s trauma registry to identify patients admitted to the trauma center from 1997 to 2007. Administrative data were used to determine re-presentation statistics, with neighborhood income being determined through census block data.

In all, 886 of 6,675 patients (13.3%) in the study made return trips to the ED within 30 days of discharge. The researchers found uninsured patients and publicly insured patients to be more likely to make these trips when compared to patients with commercial insurance. A neighborhood median household income of less than $20,000 was also associated with higher re-presentation odds, with 13.2% of the patients who came to the ED actually being readmitted to the hospital.

“Improving follow-up care for these vulnerable patients will not only improve the quality of their care, but will also ease the burden on already strained emergency departments and reduce overall health care costs,” Haider stated.

Reference:

• Ladha KS, Young JH, Ng DK, et al. Factors affecting the likelihood of presentation to the emergency department of trauma patients after discharge. Ann Emerg Med. 2011. doi:10.1016/j.annemergmed.2011.04.021.

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