Primary care access influences visits to the emergency department, study says

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Patients who had trouble accessing a primary care physician after hours were more likely to visit emergency departments, according to a new study.

Patients who had trouble gaining access to a primary care physician (PCP) after hours visited the emergency department more often than patients who had access to their physician, according to a new study.

According to the research, published in Health Affairs, more than 40% of patients with a regular PCP say the practice offered some kind of extended hours service, such as nights or weekends.

About 20% of patients who participated in the study reported trying to contact their PCP after hours. Of those patients, 20% found it “very difficult” to contact a clinician, whereas the other 80% report little to no difficulty.

Of the patients who had trouble reaching their clinicians, nearly 40% ended up visiting a local emergency department, whereas only about 30% with less difficulty went to the emergency department. Additionally, almost 14% of patients who had trouble gaining clinician access felt as though they had an unmet medical need, compared with 6.1% among the patients who were able to reach their clinician.

Children, though a parent or other adult, had the highest rates of trying to gain clinician access after hours, but pediatricians were significantly more responsive to after hours call than providers for adult patients, according to the study. Patients reporting “poor health” status and those without insurance or relying on Medicaid also reported more difficulty in reaching a physician after hours.


The study suggests that current payment and Medicaid reimbursement models don’t do enough to fairly compensate doctors for working evenings and weekends, even though after-hours care and reduced emergency department visits would go far in terms of reducing healthcare costs and fragmentation of care.

The study was funded by the National Institute for Health Care Reform and the Robert Wood Johnson Foundation.

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