Gregg Abbey, Wang Hui, Ard Brankeciara, Galafassi Marcelo Takejame, Bidgoli Maryam
Department of Community Medicine and Population Health, College of Community Health Sciences The University of Alabama Tuscaloosa Alabama USA.
Institute for Rural Health Research, College of Community Health Sciences The University of Alabama Tuscaloosa Alabama USA.
Health Care Sci. 2025 Jun 8;4(3):195-205. doi: 10.1002/hcs2.70020. eCollection 2025 Jun.
Having a primary care usual source of care (USC) is associated with better population health outcomes. However, the percent of adults in the United States (US) with a usual primary care provider is declining. We sought to identify factors associated with establishing a USC at an urgent care clinic or emergency department as opposed to primary care.
We analyzed data from 57,152 participants in the study who reported having a USC. We used the Andersen Behavioral Model of Health Services Use framework and multivariable logistic regression to examine associations among predisposing, enabling, and need factors, according to the source of usual care.
An urgent care clinic, minute clinic, or emergency department was the source of usual care for 6.3% of our sample. The odds of seeking care at this type of facility increased with younger age, lower educational attainment, and better health status. Black and Hispanic individuals, as well as those who reported experiencing discrimination in medical settings or that their provider was of a different race and ethnicity, were also less likely to have a primary care USC. Financial concerns, being anxious about seeing a provider, and the inability to take time off from work also increased the likelihood of having a non-primary care USC.
Improving the rates of having a primary care USC among younger and healthy adults may be achievable through policies that can improve access to convenient, affordable primary care. Efforts to improve diversity among primary care providers and reduce discrimination experienced by patients may also improve the USC rates for racial and ethnic minority groups.
拥有一个初级保健的常规医疗服务来源（USC）与更好的人群健康结果相关。然而，美国拥有常规初级保健提供者的成年人比例正在下降。我们试图确定与在紧急护理诊所或急诊科而非初级保健机构建立USC相关的因素。
我们分析了该研究中57152名报告有USC的参与者的数据。我们使用了健康服务利用的安德森行为模型框架和多变量逻辑回归，根据常规护理来源来检验易患因素、促成因素和需求因素之间的关联。
在我们的样本中，6.3%的人将紧急护理诊所、便捷诊所或急诊科作为常规护理来源。在这类机构寻求护理的几率随着年龄的增长、教育程度的降低和健康状况的改善而增加。黑人和西班牙裔个体，以及那些报告在医疗环境中经历过歧视或其提供者与自己种族不同的人，也不太可能有初级保健USC。经济担忧、看医生时的焦虑以及无法从工作中抽出时间，也增加了拥有非初级保健USC的可能性。
通过制定政策改善获得便捷、负担得起的初级保健服务的机会，可能会提高年轻和健康成年人中拥有初级保健USC的比例。努力提高初级保健提供者的多样性并减少患者所经历的歧视，也可能会提高种族和少数族裔群体的USC比例。
