INTRODUCTION

1. Is access to primary care the solution we have been searching for regarding emergency department utilization differences between minority and non-minority patients? Marquianna Griffin, MSPH; Stephen Notaro, PhD; I. Shevon Harvey, DrPH Department of Community Health at University of Illinois at Urbana-Champaign CONCLUSIONS SELECTED RESULTS INTRODUCTION SELECTED RESULTS cont. Table 1 - Mean Number of Visits to the ED within the Previous Year • Characteristics of patients with high ED utilization were: • Minority (Black, non-Hispanic) • Lower income • Visits to the ED for non-urgent conditions • Residing in female-headed household • Black, non-Hispanic patients tend to earn lower incomes, reside in female headed households, and visit the ED for non-urgent care in greater numbers in comparison to their White, non-Hispanic counterparts • Access to primary care can • Reduce the number of patients visiting the ED for their primary care • Potentially reduce the economic strain on the healthcare system resulting from low-income patients that incur ED cost for their primary care • The existence of free health clinics provides a primary healthcare alternative to the ED • For many minority patients, the emergency department (ED) serves as a primary healthcare facility. Minorities represent more than half of the uninsured population (Cardelli & Chiapa, 2007). Although many uninsured patients utilize the ED for non-urgent care, privately insured patients do not frequent the ED for care (Khaliq & Broyles, 2006). Utilization of EDs is not based solely on race or ethnicity. Additional factors include: • income (Suruda, Burns, Knight, & Dean, 2005) • insurance status (Todd, Armon, Griggs, Poole, & Berman, 2006) • access to primary care (Cardelli & Chiapa, 2007) • cost of care (Baker & Baker, 1994) • The disparity in ED utilization is exacerbated by the cost of care being markedly more expensive than the cost of care in a primary healthcare setting (Baker & Baker, 1994; Machlin, 2006; Newton, Keirns, Cunningham, Haywood, & Stanley, 2008). The high cost of care places a financial strain on minority patients (Cheong, Feeley, & Servoss, 2007) who reportedly earn lower incomes than their White counterparts (Boudreaux, Edmond, Clark, & Camargo, 2003). The existence of free clinics helps to offset the financial burden for minorities seeking treatment in the ED (Isaacs & Jellinek, 2007). Table 5 - Mean Yearly Income • Black, non-Hispanic patients had higher mean number visits to the ED (1.41) than Caucasian patients (1.04). • Hispanic and Black, non-Hispanic patients reported lower mean annual incomes than White, non-Hispanic patients (see Table 4) Table 2 - Percentage of Categorized Number of ED Visits in Previous Year Graph 1 - Urgency of ED Conditions (White, non-Hispanic Patients) LIMITATIONS • Higher percentages of Black, non-Hispanic patients reported they had 2 or more visits to the ED within the previous year • Self-reported data • Open-ended questions • Insurance coverage not collected on survey instrument • Number of Hispanic and “Other” patients relatively small Table 3 – Percentage for Location of Alternate Healthcare Graph 2 - Urgency of ED Conditions (Black, non-Hispanic Patients) OBJECTIVE Compare ED utilization between minority and non-minority patients Identify which factors contribute to minority patients utilizing the ED in greater numbers than their non-minority counterparts Discuss accessible primary care as a solution for patients utilizing the ED for their healthcare needs • 16.4% of Black, non-Hispanic patients reported they would have sought treatment in the ED for healthcare in the absence of CCCHC in comparison to 14.4% of White, non-Hispanic patients METHODOLOGY • Demographic Information Form inquired about patients’ demographic characteristics and health service utilization (specific focus on ED utilization) • Sample • Data compiled between 2005 and 2007 • Surveys were completed by first-time patients at the Champaign County Christian Health Center, a free health clinic in Champaign, IL (n=971) • Non-Hispanic Black/African American, non-Hispanic White/Caucasian, Hispanic, Other • Statistical analysis • The Statistical Package for Social Sciences (SPSS) was utilized to analyze the data • A chi-square analysis, bivariate statistical analysis (ANOVA) and generalized linear model were utilized to analyze the data Table 4 - Mean Number of ED Visits in Previous Year by Female Head of Household FUTURE RESEARCH RECOMMENDATIONS • The majority of White and Black, non-Hispanic patients visited the ED for non-urgent care (67.7% and 76.3%, respectively), with Black, non-Hispanic patients exhibiting a larger percentage for non-urgent care • Future studies should collect data on healthcare utilization and insurance coverage to determine if uninsured minorities frequent the ED because they lack insurance coverage • If data is utilized in free clinic setting: • Questions should provide concrete responses for data analysis • Medical records should be utilized for diagnosis as opposed to self-reported reason for visit • Research instrument should ask patients if they have insurance coverage • Analysis should study relationships between ED utilization and insurance coverage • Black, non-Hispanic patients residing in female-headed households demonstrated higher mean ED visits than White, non-Hispanic patients