Friday, June 22, 2012

Annals of EM Survey: Minor Complaints (the other GOMER)

Ok , I had to. This is something we all wonder about ( I mean ... get ragingly and tirelessly furious about).
These guys surveyed people waiting in the ED for what were determined to be MINOR complaints. The data is interesting and not entirely what I expected:

172 Why Do Patients With Minor Complaints Prefer Emergency Departments Over Primary Care
Kamali MF, Jain A, Jain M, Schneider SM/University of Rochester, Rochester, NY
Background: Emergency departments (EDs) are increasingly seeing patients with minor medical complaints.
Study Objective: Analyze why patients prefer to come to ED with minor complaints over a visit to their primary care physician (PCP).
Method: This is a survey of 400 adult patients waiting at least 15 minutes to be seen by a physician or physician extender. The patients were surveyed in the waiting area of an academic tertiary care ED from April to August 2010. The study was approved by the Institutional Review Board. Information was collected on a closed ended item questionnaire and analyzed using JMP 8.0 for Mac.
Results: Of the 400 patients studied, 20.6% did not have access to a PCP. Of the remaining patients, 56.6% had considered going to primary care for their presenting complaints, and 47.5% had called a doctor prior to ED arrival.
Reasons for choosing ED over PCP: 36% patients presented to the ED due to the concern that their problem was urgent and required immediate attention. One third of the patients (33.4%) were referred to the ED by their PCPs. 12.5% of patients reported that they could not get a timely appointment with their PCP and therefore, came to the ED. 11% patients preferred the ED because it offered more services than their PCP’s office.
We also looked at the distribution of insurance and employment status of our survey population and found that, while 54% of patients were unemployed, only 16.8% reported having no insurance of any kind. Nearly half the patients (48.5%) had Medicaid or Medicare with or without additional private medical insurance. 30.2% of the patients had private medical insurance. Only 3 patients (0.75%) felt that it was more expensive to go to the PCP than come to the ED, and 6 patients (1.5%) reported a lack of transportation to the PCP as 1 of the factors in their decision to come to the ED.
Conclusion: Our survey reveals that many patients who present to the ED with minor complaints do so because they either perceive their complaints to be urgent, or because their PCP refers them to the ED. Most of these patients have some type of insurance coverage, and financial constraints are often not a deciding factor in this preference of the ED over the PCP. This result may reflect a trend seen in health care where overburdened PCP practices refer patients to the ED. 

Volume 58, 4S : October 2011
Annals of Emergency Medicine S235

I was very surprised that 33.4% were actually referred by their PCP.
I am curious if this is because PCP's: 1) Don't like their patients , 2) Are overburdened and this is a form of "referring" 3) Are incompetent or ill-equipped to handle minor problems.

There are systemic failures at the base of this but it is interesting! Knowledge is power.

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