Capp Roberta, Camp-Binford Meredith, Sobolewski Sarah, Bulmer Sandra, Kelley Lauren
*Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, CO †School of Medicine, Yale University ‡Department of Health and Human Services, Southern Connecticut State University §Project Access New Haven, Yale New Haven Hospital, New Haven, CT.
Med Care. 2015 Jun;53(6):530-3. doi: 10.1097/MLR.0000000000000364.
The rates of annual visits for adult Medicaid enrollees to the emergency department (ED) are increasing. Many programs throughout the country are focused on engaging patients in the use of their primary care providers (PCP) rather than the ED for low acuity conditions. It is unclear, however, the proportion of patients who are willing to use primary care services rather than the ED if they are given the choice.
Cross-sectional study of adult Medicaid enrollees (18 y and older) presenting to a large, urban, academic ED from June to August 2012 with a low acuity condition was performed. We excluded patients who did not have a PCP or active Medicaid insurance. Our primary goal was to determine the proportion of patients who prefer to use the ED, rather than their PCP clinic, if an appointment was immediately available. Our second goal was to understand why patients would prefer ED over PCP care.
A total of 150 patients agreed to complete the survey, and 95 (63.3%) met our inclusion criteria. Forty-three patients (45.3%) stated preferring to use their PCPs rather than the ED if an appointment was available at that time. Thirteen (48.1%) cited that the ED had more technology or specialty care services available when compared with their PCP's clinic, 8 (15.4%) were in significant pain, and 6 (11.5%) felt the care they received in the ED was better than what they would receive in their PCP clinic.
Our study shows that a little less than half of adult Medicaid enrollees presenting to the ED with low acuity conditions would have preferred to use their PCP rather than the ED, if an appointment had been immediately available.
成年医疗补助计划参保者前往急诊科（ED）的年度就诊率正在上升。全国许多项目都致力于让患者在病情不太严重时选择使用初级保健医生（PCP）而不是去急诊科。然而，尚不清楚如果有选择的话，愿意使用初级保健服务而非急诊科的患者比例。
对2012年6月至8月前往一家大型城市学术性急诊科、病情不太严重的成年医疗补助计划参保者（18岁及以上）进行横断面研究。我们排除了没有初级保健医生或无有效医疗补助保险的患者。我们的主要目标是确定如果能立即预约，更愿意使用急诊科而非初级保健医生诊所的患者比例。我们的第二个目标是了解患者更喜欢去急诊科而非找初级保健医生看病的原因。
共有150名患者同意完成调查，其中95名（63.3%）符合我们的纳入标准。43名患者（45.3%）表示如果当时能预约，更愿意找初级保健医生而不是去急诊科。13名（48.1%）患者称与初级保健医生诊所相比，急诊科有更多的技术或专科护理服务；8名（15.4%）患者表示疼痛剧烈；6名（11.5%）患者觉得在急诊科接受的治疗比在初级保健医生诊所会得到的更好。
我们的研究表明，对于前往急诊科、病情不太严重的成年医疗补助计划参保者，如果能立即预约，不到一半的人更愿意找初级保健医生而不是去急诊科。
