Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA; Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA.
Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA.
Am J Emerg Med. 2023 Sep;71:25-30. doi: 10.1016/j.ajem.2023.06.003. Epub 2023 Jun 8.
Primary care use helps reduce utilization of more expensive modes of care, such as the emergency department (ED). Although most studies have investigated this association among patients with insurance, few have done so for patients without insurance. We used data from a free clinic network to assess the association between free clinic use and intent to use the ED.
Data were collected from a free clinic network's electronic health records on adult patients from January 2015 to February 2020. Our outcome was whether patients reported themselves as 'very likely' to visit the ED if the free clinics were unavailable. The independent variable was frequency of free clinic use. Using a multivariable logistic regression model, we controlled for other factors, such as patient demographic factors, social determinants of health, health status, and year effect.
Our sample included 5008 visits. When controlling for other factors, higher odds of expressing ED interest were observed for patients who are non-Hispanic Black, older, not married, lived with others, had lower education, were homeless, had personal transportation, lived in rural areas, and had a higher comorbidity burden. In sensitivity analyses, higher odds were observed for dental, gastrointestinal, genitourinary, musculoskeletal, or respiratory conditions.
In the free clinic space, several patient demographic, social determinants of health and medical conditions were independently associated with greater odds of reporting intent on visiting the ED. Additional interventions that improve access and use of free clinics (e.g., dental) may keep patients without insurance from the ED.
初级保健的使用有助于减少对更昂贵的医疗方式（如急诊室）的利用。尽管大多数研究都在有保险的患者中调查了这种关联，但很少有研究针对没有保险的患者进行研究。我们使用来自免费诊所网络的数据来评估免费诊所的使用与使用急诊室的意愿之间的关联。
数据来自 2015 年 1 月至 2020 年 2 月期间免费诊所网络的电子健康记录，我们的结果是如果免费诊所不可用，患者是否表示自己“非常有可能”去急诊室就诊。自变量是免费诊所的使用频率。我们使用多变量逻辑回归模型，控制了患者人口统计学因素、健康的社会决定因素、健康状况和年份效应等其他因素。
我们的样本包括 5008 次就诊。在控制了其他因素后，观察到非西班牙裔黑人、年龄较大、未婚、与他人同住、受教育程度较低、无家可归、有个人交通工具、居住在农村地区以及合并症负担较高的患者表达对 ED 感兴趣的几率更高。在敏感性分析中，观察到牙科、胃肠道、泌尿生殖、肌肉骨骼或呼吸系统疾病的几率更高。
在免费诊所环境中，患者的几个人口统计学、健康的社会决定因素和医疗状况与报告 ED 就诊意愿的几率增加独立相关。改善免费诊所的获取和使用的额外干预措施（例如，牙科）可能会使没有保险的患者避免去急诊室。
