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Open Access Publications from the University of California

Factors Influencing Emergency Department Preference for Access to Health Care

  • Author(s): Brown, Lindsay E;
  • Burton, Ryan;
  • Hixon, Brian;
  • Kakade, Manasi;
  • Bhagalia, Parul;
  • Vick, Catherine;
  • Edwards, Andrew;
  • Hawn, Mary T
  • et al.

Introduction: African-Americans are more likely than Caucasians to access healthcare through the emergency department (ED); however, the reasons behind this pattern are unclear. The objective is to investigate the effect of race, insurance, socioeconomic status, and perceived health on the preference for ED use.

Methods: This is a prospective study at a tertiary care ED from June to July 2009. Patients were surveyed to capture demographics, healthcare utilization, and baseline health status. The primary outcome of interest was patient-reported routine place of healthcare. Other outcomes included frequency of ED visits in the previous 6 months, barriers to primary care and patient perception of health using select questions from the Medical Outcomes Study Short Form 36 (SF-36).

Results: Two hundred and ninety-two patients completed the survey of whom 58% were African-American and 44% were uninsured. African-Americans were equally likely to report 3 or more visits to the ED, but more likely to state a preference for the ED for their usual place of care (24% vs. 13%, p < 0.01). No significant differences between groups were found for barriers to primary care, including insurance. African-Americans less often reported comorbidities or hospitalization within the previous 6 months (23% vs. 34%, p = 0.04). On logistic regression modeling, African-Americans were more than 2 times as likely to select the ED as their usual place of healthcare (OR 2.24, 95% CI 1.22 - 4.08).


Conclusion: African-Americans, independent of health insurance, are more likely than Caucasians to designate the ED as their routine place of healthcare. [West J Emerg Med. 2012;13(5):410-415.]

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