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With the recent implementation of the Affordable Healthcare Act in the United States, there is increased focus on preventive or primary care as a good way to lower costs for both providers and patients as well as improve health outcomes across all populations. A recent study examined whether increased access to primary care lessened patients’ need to rely upon emergency room departments to provide care. The authors were interested in whether prevention strategies could help ward off patient health crises that were either harder to treat or more expensive by the time they were diagnosed in an emergency room setting. The goal of course was to determine how much could be saved by implementing adequate prevention strategies and more strategically, how this could be accomplished. One of the biggest reasons behind the legislation passed by President Obama (the Affordable Healthcare Act) was the financial burden placed on the entire system when uninsured patients sought care at the emergency department rather than at other institutions. For example, the American College of Emergency Physicians found that the emergency departments of the United States acted as health care portals for as many as 75% of uninsured patients. In addition to the financial burden that this can bring, it also makes continuity of care difficult. Imagine a heart attack victim, for instance, who lacks access to primary care for management of high cholesterol or high blood pressure – these conditions make him much more likely to experience a subsequent cardiac event if not managed properly. The authors of the study examined an amazing 40,000 individual patient records to determine whether enrolling in a free or low-cost primary care access program subsequently affected emergency room utilization by uninsured adults. A tool called an “intensity of use indicator (IUI) was developed for tracking purposes; this noted how many times patients had used the emergency room for their treatment needs. The researchers also tracked the severity of illness during each visit, whether the patients were ultimately admitted to the hospital as a result of their ER visit, how long they had to stay in the hospital for treatment, and the total hospital charges for their care. To determine whether having access to primary care affected emergency room utilization rates, the researchers examined the records of those enrolled in the program and compared them to a set of controls. They then looked for any patterns; multivariate regression analysis was used to determine if any of the patient characteristics or physician access types were correlated with higher or lower emergency department utilization rates. As mentioned in the introduction, the IUI was calculated for each patient. This number was calculated the following way: IUI = ((total number visits/average number visits)) + (total charges/average charges) + (length of stay/average length of stay)) x 100. Across the entire patient population then, there were a variety of scores –some very high (for those patients with multiple and costly visits) and others fairly low (for those patients who rarely had to utilize the emergency department). The researchers found that the significant variables which influenced the IUI most strongly were enrollment status (i.e. access to primary care), number of visits before and during enrollment, and type of service were significant. That is, a person who did not have access to primary care was found to be significantly more likely to have a high IUI score and to have needed emergency room care which was ultimately more costly than primary care would have been. Learn more about emergency medicine jobs at Physicians Employment or by calling 800-267-6115. You can view and apply to more than 25,000 jobs in over 200 specialties, including hospitalist jobs, cardiology jobs, family practice jobs, and more.
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