papers

The effect of the doctor-patient relationship on emergency department use among the elderly

Am JPublic Health 90:97-102.

Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA

OBJECTIVES: This study sought to determine the rate of emergency department use among the elderly and examined whether that use is reduced if the patient has a principal-care physician.

METHODS: The Health Care Financing Administration’s National Claims History File was used to study emergency department use by Medicare patients older than 65 years in Washington State during 1994.

RESULTS: A total of 18.1% of patients had 1 or more emergency department visits during the study year; the rate increased with age and illness severity. Patients with principal-care physicians were much less likely to use the emergency department for every category of disease severity. After case mix, Medicaid eligibility, and rural/urban residence were controlled for, the odds ratio for having any emergency department visit was 0.47 for patients with a generalist principal-care physician and 0.58 for patients with a specialist principal-care physician.

CONCLUSIONS: The rate of emergency department use among the elderly is substantial, and most visits are for serious medical problems. The presence of a continuous relationship with a physician–regardless of specialty–may reduce emergency department use.

PMID: 10630144

PMCID: PMC1446125