Treating patients seeking primary care after emergency room visits

When a patient visits an emergency room (ER) for treatment of an injury or illness, follow up care is often recommended. Unfortunately, many patients who use the ER for such visits do so because they do not have an established primary care physician. A recent study found that patients who do try to follow up their ER visit with a primary care physician may not be able to get a timely appointment.

A research study, published in the Annals of Emergency Medicine and presented at the American College of Emergency Physicians Scientific Assembly Research Forum, October 2016, Las Vegas, NV, focused on “Insurance Status and Access to Urgent Primary Care Follow-up After an Emergency Department Visit.” The study employed 2 African American men who posed as recent emergency room patients seeking a follow up visit with a primary care physician.

The research participants made a total of 604 calls that covered “all possible scenarios based on 3 insurance types (Medicaid, state exchange, and commercial) and 2 conditions (hypertension and back pain).” Overall, they were able to secure a follow up appointment within 7 days only 30.7% of the time. The 7-day appointment rate for those presenting themselves as being diagnosed with hypertension was 33.7% and for those presenting themselves with lower back pain was 27.6%.

When the participants presented themselves as Medicaid recipients, their 7-day appointment rate was lowered to 25.5%. 94 of the calls made as Medicaid recipients were declined completely, with the primary care physician’s office citing the fact that they did not accept Medicaid or that their number of Medicaid patients for the month had reach its limits.

Overall, the study “found access to 7-day follow-up appointments to be difficult across all insurance statuses and clinical conditions compared with previous studies conducted in other cities.” Researchers recommended, based on the results of this study as well as others recently conducted, that “EDs should actively assess the availability of and access to primary care follow-up in the local community and, if needed, consider alternative approaches to discharge care transitions, such as providing 30-day prescriptions of antihypertensives or scheduled follow-up in the ED.”