Emergency Room Visits Climb Amid Primary Care Shortages, Study Results Show

By James Arvantes
8/27/2008

Emergency rooms now serve as the main source of health care for a growing segment of the U.S. population that lacks adequate access to primary care services. That's according to a new CDC study. (39-Page PDF; About PDFs)

The annual number of emergency department visits jumped from 90.3 million in 1996 to more than 119 million in 2006, a 32 percent increase. At the same time, the percentage of nonobstetric hospital admissions that came through emergency departments climbed from 36 percent in 1996 to 50 percent in 2006, according to the study, which is based on various components of the CDC's National Center for Health Statistics' National Health Care Survey.

"This means that a lot of diagnostic work is being done in the ER, and it is prolonging ER stays," said Stephen Pitts, M.D., M.P.H., a fellow at the National Center for Health Statistics and an associate professor of emergency medicine at Emory University, who led the study.

The study does not address reasons for the increases in ER use, but the findings strongly suggest that the growing use of emergency departments is directly related to the shortage of primary care physicians. Without a regular and continual source of care, patients are more likely to turn to emergency departments for treatment, said Pitts in an interview with AAFP News Now.

The study results have profound implications, cutting across the critical dimensions of access, cost and quality and serving as another reminder that the nation relies on a health care system that is too costly, too fragmented and lacking in overall quality in too many instances, said Pitts. In addition, the high rate of emergency department use serves as a strong indictment of the nation's shortage of primary care physicians, while underscoring the need for the patient-centered medical home, he added.

"A patient-centered medical home would remove some of this burden by educating patients and being accessible at the time of need," said Pitts.

The study also reached the following conclusions.

Patients with Medicaid use the emergency department more frequently than patients with private insurance -- 82 per 100 persons for Medicaid compared with 21 per 100 for private insurance. Medicaid patients have a harder time finding physicians who will treat them than do patients with private insurance, which accounts for the disparities in ER visits, Pitts said.
The average waiting time to see a physician in the emergency department was 56 minutes.
The rate of visits per 100 persons was about 36 percent for whites compared with nearly 80 percent for blacks, a fact that Pitts attributed to many blacks' lower socioeconomic status and, consequently, their decreased access to physicians outside of ERs. Cultural factors also could play a role in discouraging blacks from seeking care from places other than ERs, Pitts said.
The rate of visits per 100 persons for Hispanics was about 35 percent, lower than the rate for whites. Pitts said this statistic could be a result of language and cultural barriers that make Hispanics less likely to report their visits to ERs.
Most ER visits occurred after normal business hours -- 8 a.m. to 5 p.m. on weekdays -- when 63 percent of adults and 73 percent of children younger than 15 came in.

The study also shows that the reasons for ER visits vary by age and gender. For children and teenagers younger than 15, the study cited fever, cough and vomiting as the three main reasons for ER visits. In females ages 15 and older, the three main reasons were stomach and abdominal pain, chest pain and related symptoms, and headaches.

In males ages 15 and older, the number one reason for ER visits was chest pains and related symptoms followed by stomach and abdominal pain, and back symptoms.

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