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

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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Small-area Variation in Hypertension Prevalence among Black and White Medicaid Enrollees

Ethnicity & Disease ◽

10.18865/ed.26.3.331 ◽

2016 ◽

Vol 26 (3) ◽

pp. 331 ◽

Cited By ~ 3

Author(s):

Kellee White ◽

John E. Stewart ◽

Ana Lòpez-DeFede ◽

Rebecca C. Wilkerson

Keyword(s):

Primary Care ◽

South Carolina ◽

Primary Care Physician ◽

Small Area ◽

Care Physician ◽

Fiscal Year ◽

Hypertension Prevalence ◽

Black And White ◽

Care Plans ◽

Blacks And Whites

Objectives: To examine within-state geographic heterogeneity in hypertension prevalence and evaluate associations between hypertension prevalence and small area contextual characteristics for Black and White South Carolina Medicaid enrollees in urban vs rural areas. Design: Ecological Setting: South Carolina, United States. Main Outcome Measure: Hypertension prevalence Methods: Data representing adult South Carolina Medicaid recipients enrolled in fiscal year 2013 (N=409,907) and ZIP Code Tabulation Area (ZCTA)-level contextual measures (racial segregation, rurality, poverty, educational attainment, unemployment and primary care physician adequacy) were linked in a spatially referenced database. Optimized Getis-Ord hotspot mapping was used to visualize geographic clustering of hypertension prevalence. Spatial regression was performed to examine the association between hypertension prevalence and small-area contextual indicators. Results: Significant (alpha=.05) hotspot spatial clustering patterns were similar for Blacks and Whites. Black isolation was significantly associated with hypertension among Blacks and Whites in both urban (Black, b=1.34, P<.01; White, b=.66, P<.01) and rural settings (Black, b=.71, P=.02; White, b=.70, P<.01). Primary care physician adequacy was associated with hypertension among urban Blacks (b=-2.14, P<.01) and Whites (b=-1.74, P<.01). Conclusions: The significant geographic overlap of hypertension prevalence hotspots for Black and White Medicaid enrollees provides an opportunity for targeted health intervention. Provider adequacy findings suggest the value of ACA network adequacy standards for Medicaid managed care plans in ensuring health care accessibility for persons with hypertension and related chronic conditions. Ethn Dis. 2016;26(3):331-338; doi:10.18865/ed.26.3.331

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Exploring emergency department visits: factors influencing individuals’ decisions, knowledge of triage systems and waiting times, and experiences during visits to a tertiary hospital in Saudi Arabia

International Journal of Emergency Medicine ◽

10.1186/s12245-019-0254-7 ◽

2019 ◽

Vol 12 (1) ◽

Author(s):

Nawaf Alhabdan ◽

Faisal Alhusain ◽

Abdulkareem Alharbi ◽

Muatassem Alsadhan ◽

Moath Hakami ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Primary Care Physicians ◽

Waiting Times ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Care Physician ◽

Emergency Department Visits ◽

Cross Sectional ◽

Validated Questionnaire

Abstract Background In recent years, there has been an increased utilization of emergency departments (EDs) in many countries. Additionally, it is reported that there are major delays in delivering care to ED patients. Longer waiting times are associated with poor patient satisfaction, whereas an understanding of the triage process increases satisfaction. This study aimed to assess ED visitor’s awareness of the triage procedure and their preferences regarding delayed communication. Methods Cross-sectional study of King Abdulaziz Medical City – Emergency Department visitors using a previously validated questionnaire (Seibert 2014) which was translated to Arabic, piloted, and then used for this study. Results A total of 334 questionnaires were returned. The mean age of respondents was 33 years. Regarding primary care physicians, only 16% of respondents said that they have one. About 21% of those tried to communicate with them before coming to the ED. Even though only 11% of respondents knew exactly what triage is, 51% were able to correctly explain why some patients are seen before others. Statistical analysis did not show any factors that are associated with increased knowledge of triage. Most respondents (75%) want to hear updates regarding delays with 69% of them preferring to be updated every 30 min. Conclusions This study showed that the majority of patients do not know what triage means and that most of them want to know how the ED works. Moreover, a lot of respondents said that they do not have a primary care physician. These results support increasing patient awareness by education and involving them if any delay happens.

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