MedicalResearch.com: What are the main findings of the study?
Dr. Haggins: Since the implementation of the Children’s Health Insurance Program (CHIP) in 1997, the last national health care reform that broadly expanded insurance coverage, adolescent use of primary care and specialty care has increased substantially in comparison to no change seen among the comparison group (young adults, who were not covered). Broadening insurance coverage for adolescents did not result in a decrease in emergency department use, while ED use in the comparison group increased over time.
MedicalResearch.com: Were any of the findings unexpected?
Dr. Haggins: We hypothesized that improved access to primary and specialty care would decrease reliance on ED services over time. However, our analysis over the course of the years 1992-2009 demonstrated a persistent and steady trend in ED use.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Haggins: Outpatient clinicians work within a system of finite resources where barriers to accessing primary care and specialty care can influence ED use. Examining trends in both the outpatient clinics and EDs demonstrated the increasing demand for health care services in both settings. Therefore, as the nation prepares for the next major expansion of coverage, additional interventions informed by patients’ usage patterns, along with their expectations and preferences for care will likely be needed to optimize access to ambulatory health care services.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Haggins: In examining the effect of the Affordable Care Act and the capacity of ambulatory care to accommodate the newly insured, it will be important to assess both ED and outpatient use. It will also be important to understand the factors patients find most important in deciding when and where to seek care as health care systems attempt to align health care resources with patient preferences and health care needs.
- Presented at The Robert Wood Johnson Foundation Clinical Scholars National Meeting, November 2011; the Society for Academic Emergency Medicine Annual Meeting, May 2012; and the Academy Health Annual Academic Research Meeting, June 2012.
- Funded through the Robert Wood Johnson Foundation Clinical Scholars Program. Dr. Patrick has been a consultant with Vermont Oxford Network. The other authors have no disclosures or conflicts of interest to report.