50. The Influence of Primary Care Provider Type on Adolescent Visits to the Emergency Department

Abstract

Purpose: Adolescents frequently rely on emergency departments (EDs) for medical care, rather than using primary care providers (PCPs). Previous studies have examinedEDuse by young children and adults, but no recent studies have looked specifically at adolescents’ use of the ED. Our objectives were to characterize a population of adolescents presenting to a large, urban children’s hospital ED and to examine if the type of PCP or primary clinic (academic, community, or private) they reported attending influenced their triage level or reason for presenting to the ED rather than to their PCP. Methods: Adolescents ages 12 to 21 and their parents/guardians were approached in either the ED waiting room or patient care rooms and invited to participate. Age-eligible patients were excluded if they required immediate emergent care, were under 18 and not accompanied by a consenting adult, or could not complete the survey in either English or Spanish. We used a brief, online, 21-question survey to assess key characteristics of the PCP practice and the adolescents’ relationship to the PCP as well as their main reason for presentation to the ED instead of to the PCP. Demographic data and triage information were collected from participants’ electronic medical records. PCPs were classified by study staff as academic, community, or private based on the provider or clinic name supplied by each participant. Descriptive statistics were performed. Results: Of the 203 total participants from August 2010 to February 2011, 60% (n 121) were female and 80% (n 162) were Black/ African American, with a median age of 15 years (S.D. 2.37). Twothirds (66%, n 134) had a formof public insurance (Medicaid, CHIPs, etc), and 40% (n 82) were triaged as non-urgent. Nearly all (93%, n 189) reported that they had a PCP or primary clinic, and most were able to state a provider or clinic name. Forty-six percent (n 94) had a private PCP, 23% (n 46) had an academic PCP, and 21% (n 42) had a community-based PCP. Those with an academic PCP were slightly more likely (p 0.051) to be triaged as urgent compared to those with a community PCP. There were no other significant differences in triage level among groups of participants by PCP type. When asked to choose their main reason for presenting to the ED instead of to the PCP, those with private PCPs most commonly reported PCP instructions to go to the ED (31%, n 29) compared to those with academic and community PCPs who most frequently presented to the ED due to perceived illness requiring immediate care (37%, n 17 and 40%, n 17 respectively). Conclusions: Nearly all adolescents in this study were able to identify a PCP or primary clinic during their ED visit, most frequently from a private office setting. However, those with private PCPs most commonly reported being sent to the ED by their PCPs. Further research is needed examining why private PCP offices divert adolescents to the ED—perhaps discomfort in caring for this age group, issues with time constraints in the outpatient setting, or inadequate reimbursement. Sources of Support: None. 51.