Published Date: February 14, 2023

Summary: Authors sought to examine specific care-seeking behaviors and experiences, access indicators, and patient care management approaches associated with frequency of emergency department (ED) visits among patients of Health Resources and Services Administration-funded health centers that provide comprehensive primary care to low-income and uninsured patients. They used cross-sectional data of a most recent nationally representative sample of health center adult patients aged 18–64 (n = 4,577) conducted between October 2014 and April 2015. These data were merged with the 2014 Uniform Data System to incorporate health center characteristics. 

Authors measured care-seeking behaviors by whether the patient called the health center after hours, for an urgent appointment, or talked to a provider about a concern. Access to care indicators included health center continuity of care and receipt of transportation or translation services. Receipt of care coordination and specialist referral were included as care management indicators. A multilevel multinomial logistic regression model was used to identify the association of independent variables with number of ED visits (4 or more visits, 2–3 visits, 1 visit, vs. 0 visits), controlling for predisposing, enabling, and need characteristics.

Findings: Calling the health center after-hours (OR = 2.41) or for urgent care (OR = 2.53), and being referred to specialists (OR = 2.36) were associated with higher odds of four or more ED visits versus none. Three or more years of continuity with the health center (OR = 0.32) was also associated with lower odds of four or more ED visits versus none. Findings underscore opportunities to reduce higher frequency of ED visits in health centers, which are primary care providers to many low-income populations. Findings highlight the potential importance of improving patient retention, better access to providers afterhours or for urgent visits, and access to specialist as areas of care in need of improvement.

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