How Low-Income Residents Decide Between Emergency and Primary Health Care for Non-Urgent Treatment

Abstract

Overcrowding in U.S. emergency departments (ED) is a growing national problem that results in delayed or obstructed care and costs taxpayers billions of dollars each year. Studies show that access to a primary health care home reduces ED use, but more research is needed to determine how to best redirect vulnerable populations to primary care. Using data from forum group discussions with residents in a low-income, urban community, this study examined the decision processes residents used to decide whether to seek primary versus emergency care. Although residents exhibited high levels of knowledge about the primary health care resources available to them, they voiced a number of negative attitudes toward the services and identified barriers that discouraged them from taking advantage of these resources. The implications of these findings for campaigns aimed at discouraging non-emergency use of emergency services and promoting primary health care use, and studies of vulnerable populations’ access to primary health care more generally are discussed.

KEYTERMS:

• emergency health care
• health care decision making
• health disparities
• primary health care

Acknowledgments

This research was funded by the Department of Health and Human Services Health Resources and Services Administration (Award No.: 1 D1DHP16338-01-00). We would like to acknowledge the contributions made by community members Travie Leslie, Columbus Ward, and Nora Williams, and graduate students Casey Black and Lauren Baggett as part of our research team. We would also like to thank Vikki Katz for feedback on an earlier version of this article.

Notes

Community-based participatory research is a collaborative research approach in which community members, researchers, and other vested parties are equally involved from the onset of a research project to its conclusion (Israel, Schulz, Parker, & Becker, 2001).

These figures, provided by Grady Hospital EMS, do not account for the percentage of residents who use the ED for non-emergencies as walk-ins. The community members working on our project have suggested that this is a common occurrence made easier by a bus that runs through the community that takes people directly to the hospital.

The local clinic is aware of this problem and has been trying various ways to improve the quality of interactions between staff and patients. However, these groups’ comments indicate that they need to do more to change the community's perception of staff.