Q&A: What the Flint water crisis can teach us about COVID-19
Researchers are applying an analysis of emergency visits during the Flint, Michigan, water crisis to the COVID-19 outbreak, suggesting that strong relationships with primary care providers can cut down on unnecessary ED visits and reduce children’s exposure to the disease and other complications.
Healio Primary Care spoke with David Slusky, PhD, associate professor of economics at the University of Kansas, and lead author of the Flint study, about what its findings mean in the context of the COVID-19 pandemic. – by John Schoen and Janel Miller
Q: Can you give us the background to your study? What inspired your research?
A: Health policy scholars are interested in finding ways to reduce the use of expensive resources, such as the emergency department, without making people worse off. We had previously studied the Flint water switch in other contexts, so we were familiar with the details and the timeline. When given the chance to work with Medicaid data for the entire state of Michigan, we saw an opportunity to study how the information about potential lead poisoning increased primary care visits, which in turn may have affected emergency department usage.
Q: What did the findings from your paper show?
A: Information provided by local and county governments in Michigan warning of potential lead poisoning increased lead tests performed on small children from low-income households by 49%, and then led to 8.2% fewer avoidable emergency room visits. For example, a child with asthma prior to the Flint water contamination would go to the emergency department every time a flare-up occurred because he or she didn’t see a primary care provider on a regular basis. But because of the lead contamination, the child became an established patient at a primary care provider’s office. So, the next time the child had an asthma flare-up, he or she went to the primary care provider’s office instead of the emergency department. This scenario played out across several common emergency conditions for kids, such as respiratory infections, skin infections and stomach pain.
Q: How does your paper on lead poisonings in Flint relate to the COVID-19 pandemic?
A: We are in a situation now where emergency rooms and inpatient beds are at great risk for overcrowding. Our research shows that a relationship with a primary care provider can help individuals avoid emergency room visits. That relationship also applies in our COVID-19 pandemic, where many infected individuals can call, have a video chat, or conduct an in-person visit with their primary care provider and avoid the emergency room where they may contribute to overcrowding and infect others.
Q: Can you talk about the connection between primary care and emergency care, particularly in low-income communities?
A: As private health insurance moves toward higher and higher deductibles and, therefore, large out-of-pocket expenses from emergency room visits, many on Medicaid still have no out-of-pocket costs and, therefore, less of a disincentive to visit the emergency room. So, it is all the more important that these individuals have established relationships with primary care providers so they can avoid the emergency room whenever possible.
Q: What is your take-home message for front-line clinicians?
A: Establish and maintain relationships with patients, provide ways that those patients can video chat with a provider 24 hours a day, 7 days a week and find a way to get reimbursed for those services.
Reference: Danagoulian S, et al. Office visits preventing emergency room visits: Evidence from the Flint water switch. IZA Institute of Labor Economics. March 2020. https://www.iza.org/publications/dp/13098/office-visits-preventing-emergency-room-visits-evidence-from-the-flint-water-switch. Accessed April 30, 2020.
Disclosure: The authors report no relevant financial disclosures.
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