Would More Primary Physicians Lower Emergency Room Admittance?

Nowadays, access to healthcare is one of the most popular topics among society. Being a part of the health system in a nation as large as the United States means constantly ensuring that citizens receive the medical care they need whenever necessary. According to the Centers for Disease Control and Prevention, over 136 million visits are made to one of around 5,000 emergency rooms in the U.S. per year. 1 in 5 Americans will make a visit to the ER at least once a year. What’s more, 12% will result in admission and as many as 65% will be defined as unnecessary and wasted work hours. Naturally, emergency room patients receive 1 of 5 levels of care – 1 being for minor problems and 5 being for more severe problems. The most common reason why there are several emergency rooms is due to the fact that ERs within hospitals required by law to grant care to all patients, in spite of their financial situation. This, in turn, puts a huge strain on ERs and limits their ability to attend to real emergency settings in a much quicker manner.

In order to lower emergency room admittance, it is important that patients are aware that they should make an appointment with their primary care physician at appropriate times. Throughout the years, primary care physicians have went on to state this matter and now, according to a fairly new study conducted in California, there is sufficient data to support it. Nadereh Pourat, professor of health policy and main author of the study, analyzed the significance of ongoing relationships between primary care physicians and their patients. Together with his team, the researchers hoped to learn whether a solid relationship with a healthcare professional could, in fact, reduce the rates of hospital admissions and ER visits. The researchers found that patients who remained with their initial primary care physician had a higher chance of experiencing no hospital admissions or emergency room visits. “Primary care providers have probably been saying this for years, but by actually quantifying that impact, it can get the attention of policymakers” said Pourat.

The study took into consideration patients who had not been insured for a longer period of time and had no other access to healthcare. During the first 24 months of the study, researchers found that only around 40% remained loyal to their primary care physician. “The chronically uninsured go wherever they can to get care. They go to one provider because of short waiting times and go to another for other services. Once they got coverage, they did not change their behavior” said Pourat.
During the 3rd year of the study, it was mandatory for patients to see their primary care physician for non-urgent care and they could only switch healthcare professionals two times a year. “If a patient stays with the same provider, you build rapport with the physician, who understands the patient's history and can focus on weight reduction, getting more exercise, taking medication more regularly and also knows what medication has bad side effects. You lose a lot of those interactions when the patient moves around” said Pourat. The researchers noticed that a small drop in hospital admission and emergency room visits could account for major financial savings in healthcare. They also noted that additional research would need to be conducted to determine how many physician visits could be considered avoidable.

Another study looked at simple approaches that could decrease ER visits to treat the side effects of cancer treatment and assist patients in receiving the proper care that they require. “The overuse of emergency rooms is driving up healthcare costs and can hurt the quality of patient care in many ways” said Gregory Masters, ASCO representative. According to the study involving the participation of 5 hospitals in the South Florida area), a telephone triage service, along with proper patient education, showed a decrease in the utilization of emergency room services by up to 60%. This result was seen within the first 16 weeks of the study.

The telephone triage service was developed to assist patients in their needs. The center’s staff members were trained to take calls, identify the severity of patients’ symptoms, and distinguish when admission to the ER was considered necessary. Moreover, a triage nurse was appointed to offer consultation services. “By implementing this new system, our goal was to reduce unnecessary patient discomfort, interruptions in treatment, and financial burden. This triage system is applicable to all patients on active treatment, regardless to the type of therapy they are receiving. We believe that other oncology practices could easily mimic our model” said Brian Hunis, Medical Oncologist in the Florida area and lead author of the study.

The next part of the study involved educating patients about the side effects of chemotherapy and how to cope with such difficulties on their own. Each patient received a ‘chemotherapy passport’ with his or her oncologist’s name, their phone number, his or her personalized chemotherapy plan, the date of their last chemotherapy round, as well as specific side effects that could lead them to be hospitalized. The researchers then developed a program designed to lower ER admissions and lead quality improvement rates in practices and hospitals.

According to a recent report from the RAND Corporation, primary care physicians are gradually depending on emergency rooms to analyze and hospitalize their more ill and complex-case patients whenever appropriate. “One of the most important elements of patient-centered care is deciding when individuals can't be safely managed in community settings. Emergency physicians are trained to rapidly evaluate a wide array of conditions that are complex or time sensitive, and facilitate observation or admission of the most acutely ill patients. The study also suggests that the biggest challenge facing most ERs is trying to meet the needs of the growing population of Medicare age. Whether you live in a big city or a rural area, trying to find the right level of care for seniors with not one but several medical conditions is an ongoing struggle that plays out nights, weekends, and holidays at the front door to the hospital. Emergency departments are as vital as medical homes in every medical community” said Dr. Wes Fields, leader of the Emergency Medicine Action Fund. Clearly, “efforts to reduce non-urgent and non-emergency use of emergency departments oversimplify a complex problem, and should instead focus on increasing access to affordable options outside the emergency room” said Dr. Andy Sama, emergency physician and president of the American College of Emergency Physicians (ACEP).

As a primary care physician, you treat individuals and not medical conditions. By solidifying patient relationships, you can help them to address their needs and guide them towards the care that they require. Moreover, by regularly incorporating preventive medicine in patient consultations, you are providing a comprehensive overview of health and promoting health literacy in a general sense. The most common forms of preventive care include the following:

• Screening and early identification of chronic medical conditions and diseases;
• Immunization at the appropriate stages in patients’ lifetime;
• Preventative advice and consulting on general health-related matters and specific health risks targeted to patients’ gender, age, family history, and current health;
• Consultation on patients’ ability to maintain their own health and well-being, as well as to prevent disease, disability, and death;

Not only do you provide preventative care directly to your patients, you also play a role in providing preventative care among other patients. Your referrals to other healthcare professionals can bring about positive results on patient outcomes in general. Furthermore, by having access to reports and patients’ feedback, you can synchronize findings to recommend additional steps. You have the ability to help your patients benefit from better health, to eliminate unnecessary hospital admissions and ER visits, to drive down healthcare costs, as well as to improve overall quality of care.