Paper
Friday, July 13, 2007
Assessing the influence of a primary care health center on accident and emergency department use in a rural community
Betty Smith-Campbell, PhD, RN, School of Nursing, Wichita State University, Wichita, KS, USA
| Learning Objective #1: Discuss how health policy, through health centers, in the US impacts the use of accident and emergency departments for primary care especially for vulnerable populations. |
| Learning Objective #2: State the influence a primary health center had on accident and emergency department visits by the medically underserved in one US rural community. |
Health policy in the United States (US), or lack of, has lead to a fragmented health care system that often leaves the most vulnerable, the poor or people living in rural communities, with limited options in seeking preventative or primary health care. There is no right to health care in the US, the exception is a national policy that requires hospitals to see and triage all patients coming to their accident and emergency department (ED or A&E). Similar to other countries, ED utilization has been increasing in the US for non-emergent conditions that could be treated in primary care settings. National funding is available for Health Centers (HC), in some US communities, which provide comprehensive primary and preventive health care services to the medically underserved. Many of these services are often provided by nurse practitioners and certified nurse midwives. There is some evidence that such HCs decrease non-emergent ED use by the medically underserved. Findings from a recent collaborative research project with a local rural hospital and health center, suggest that after the HC was established, there was a decrease in ED visits for primary care conditions and non-emergent visits, by the medically underserved. This resulted in potential cost savings of over $1 million (US$). Building on these findings, the specific aims of this study were to 1) assess changes in ED use, pre and post HC, in conditions where the HC had initiated specific intervention strategies (dental care, Diabetes...) and 2) evaluate ED use when the HC was not open, and assess if a new intervention strategy of increasing HC hours might be useful. Initial results found an increase in ED visits for Dental Caries and a decrease in visits related to Diabetes.