Suicide Attempt Presentations at the Emergency Department: Outcomes From a Pilot Study Examining Precipitating Factors in Deliberate Self-Harm and Issues in Primary Care Physician Management

Objective. This study documents the influence of having an assigned Medicaid primary care physician (PCP) on the utilization of otitis media–related services. Design/Methods. This is a retrospective study using the 1991 Colorado Medicaid administrative database that followed 28 844 children <13 years who had at least 1 visit for otitis media. Results. Children continuously enrolled in Medicaid throughout the entire year were >4 times (odds ratio: 4.2 and 4.89, respectively) as likely to always or sometimes have a PCP compared with children who were discontinuously enrolled. The likelihood of ever using the emergency department for an otitis media–related visit was increased by 26% and 50%, respectively, when a child sometimes or never had a PCP compared with always having a PCP. The likelihood of ever filling an antibiotic for otitis media was reduced by 23% and 34%, respectively, when a child sometimes or never had a PCP compared with always having a PCP. The likelihood of ever having otitis media–related surgery was not affected by PCP status, but young children, 13 to 18 months of age, had higher referral rates when they had an assigned PCP. Conclusions. These findings suggest that having an assigned Medicaid PCP influences the utilization patterns of some otitis media–related medical services.

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LO078: The immigrant effect: a barrier to accessing primary and emergency department care - a Canadian population cross-sectional study

CJEM ◽

10.1017/cem.2016.115 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S57-S57

Author(s):

R. Ohle ◽

H. Bleeker ◽

J.J. Perry

Keyword(s):

Primary Care ◽

Emergency Department ◽

Primary Care Physician ◽

Odds Ratio ◽

Care Physician ◽

Model Parameters ◽

Emergency Department Care ◽

Canadian Population ◽

Study Population ◽

Immigrant Effect

Introduction: In 2011, Canada had a foreign-born population of about 6,775,800 people. They represented 20.6% of the total population, the highest proportion among the G8 countries. Immigrants encounter significant barriers to accessing primary healthcare. This is thought to be due to lower education level, employment status and the healthy immigrant effect. Our objective was to assess in an immigrant population without a primary care physician, would similar socioeconomic barriers also prevent access to the emergency department. Methods: Data regarding individuals’ ≥12 years of age from the Canadian Community Health Survey, 2007 to 2008 were analyzed (N=134,073, response rate 93%). Our study population comprised 15,554 individuals identified without a primary care physician who used emergency department care. Socioeconomic variables included employment, health status, and education. Covariates included chronic health conditions, mobility, gender, age, and mental health. Prevalence estimates and confidence intervals for each variable were calculated. Weighted logistic regression models were constructed to evaluate the importance of individual risk factors and their interactions after adjustment for relevant covariates. Model parameters were estimated by the method of maximum likelihood. The Wald statistic was employed to test the significance of individual variables or interaction terms in relation to ED choice. Results: Our study population included 1,767 immigrants and 13,787 Canadian born respondents from across Canada without a primary care physician (57.3% male). Immigrants were less likely to use the emergency department then Canadian born respondents (Odds Ratio 0.4759 (95%CI 0.396-0.572). Adjusting for health, education or employment had no effect on this reduced access (Odds Ratio 0.468 (95%CI 0.378-0.579). Conclusion: In a Canadian population without a primary care physician, immigrants access the emergency department less then Canadian born respondents. However this effect is independent of previously reported social and economic barriers. Immigration status is an important but complex component of racial and ethnic disparity in access to care. Specific policy and system development targeting this at risk population are required to allow for equal access to healthcare.

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The role of primary care physician and cardiologist follow-up for low-risk patients with chest pain after emergency department assessment

American Heart Journal ◽

10.1016/j.ahj.2014.05.016 ◽

2014 ◽

Vol 168 (3) ◽

pp. 289-295 ◽

Cited By ~ 14

Author(s):

Andrew Czarnecki ◽

Julie T. Wang ◽

Jack V. Tu ◽

Douglas S. Lee ◽

Michael J. Schull ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Chest Pain ◽

Primary Care Physician ◽

Care Physician ◽

Low Risk ◽

Risk Patients

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0781 - SMALL AREA PRIMARY CARE PHYSICIAN SUPPLY IS ASSOCIATED WITH FEWER CHILD EMERGENCY DEPARTMENT VISITS FOR ASTHMA

10.26226/morressier.5b5f433cb56e9b005965b769 ◽

2018 ◽

Author(s):

Stevens Gregory

Keyword(s):

Primary Care ◽

Emergency Department ◽

Primary Care Physician ◽

Small Area ◽

Care Physician ◽

Emergency Department Visits ◽

Physician Supply

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Factors associated with choosing the emergency department as the primary access point to health care: a Canadian population cross-sectional study

CJEM ◽

10.1017/cem.2016.350 ◽

2016 ◽

Vol 19 (04) ◽

pp. 271-276

Author(s):

Robert Ohle ◽

Michelle Ohle ◽

Jeffrey J. Perry

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Emergency Department ◽

Primary Care Physician ◽

Low Socioeconomic Status ◽

Access Point ◽

Care Physician ◽

Individual Risk ◽

Factors Associated

Abstract Objective Approximately 4.3 million Canadians are without a primary care physician, of which 13% choose the emergency department (ED) as their regular access point to health care. We sought to identify factors associated with preferential ED use over other health services. We hypothesized that socioeconomic barriers (i.e., employment, health status, education) to primary care would also prevent access to ED alternatives. Methods Data from the Canadian Community Health Survey, 2007 to 2008, were analysed (N=134,073; response rate 93.5%). Our study population comprised 14,091 individuals identified without a primary care physician. Socioeconomic variables included employment, health, and education. Covariates included chronic health conditions, immigrant status, gender, age, and mental health. Prevalence estimates and 95% confidence intervals (CIs) for each variable were calculated. Weighted logistic regression models were constructed to evaluate the importance of individual risk factors and their interactions after adjustment for relevant covariates. Results The sample comprised 57.2% males from across Canada. Employment (OR 0.73 [95% CI: 0.59-0.90]), good health (OR 0.73 [95% CI 0.57-0.88]), and post-secondary education (OR 0.68 [95% CI 0.53-0.88]) reduced respondents use of the ED. The reduced odds of ED use were independent of chronic conditions, mental health, gender, poor mobility, province, and age. Conclusions Low socioeconomic status dictates preferential ED use in those without a primary care physician. Specific policy and system development targeting this at-risk population are indicated to alter ED use patterns in this population.

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159: From the Emergency Department to a Community office – Primary Care Physician Follow Up of Buckle Fractures of the Distal Radius

Paediatrics & Child Health ◽

10.1093/pch/20.5.e91a ◽

2015 ◽

Vol 20 (5) ◽

pp. e91-e91

Author(s):

E Koelink ◽

L Barra ◽

J Stimec ◽

A Howard ◽

S Schuh ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Primary Care Physician ◽

Distal Radius ◽

Care Physician

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The immigrant effect: factors impacting use of primary and emergency department care – a Canadian population cross-sectional study

CJEM ◽

10.1017/cem.2017.4 ◽

2017 ◽

Vol 20 (2) ◽

pp. 260-265 ◽

Cited By ~ 1

Author(s):

Robert Ohle ◽

Helena Bleeker ◽

Krishan Yadav ◽

Jeffrey J. Perry

Keyword(s):

Primary Care ◽

Health Care ◽

Emergency Department ◽

Health Status ◽

Primary Care Physician ◽

Odds Ratio ◽

Access Point ◽

Care Physician ◽

Immigrant Population ◽

Canadian Population

AbstractObjectiveIn 2011, Canada had a foreign-born population of approximately 6,775,800. They represented 20.6% of the total population. Immigrants possess characteristics that reduce the use of primary care. This is thought to be, in part, due to a lower education level, employment, and better health status. Our objective was to assess whether, in an immigrant population without a primary care physician, similar socioeconomic factors would also reduce the likelihood of using the emergency department compared to a non-immigrant population without primary care.MethodsData regarding individuals ≥ 12 years of age from the Canadian Community Health Survey from 2007 to 2008 were analysed (n=134,073; response rate 93%). Our study population comprised 15,554 individuals identified without a primary care physician who had a regular place for medical care. The primary outcome was emergency department as a regular care access point. Socioeconomic variables included employment, health status, and education. Covariates included chronic health conditions, mobility, gender, age, and mental health. Weighted logistic regression models were constructed to evaluate the importance of individual risk factors.ResultsThe sample of 15,554 (immigrants n=1,767) consisted of 57.3% male and 42.7% female respondents from across Canada. Immigrants were less likely than Canadian-born respondents to use the emergency department as a regular access point for health care (odds ratio=0.48 [95% CI 0.40 – 0.57]). Adjusting for health, education, or employment had no effect on this reduced tendency (odds ratio=0.47 [95% CI 0.38 – 0.58]).ConclusionIn a Canadian population without a primary care physician, immigrants are less likely to use the emergency department as a primary access point for care than Canadian-born respondents. However, this effect is independent of previously reported social and economic factors that impact use of primary care. Immigration status is an important but complex component of racial and ethnic disparity in the use of health care in Canada.

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