September 7th, 2010
05:21 PM ET

More patients turning to ER for acute care

Where would you go if you had stomach pain? What about a really bad cough? Or a fever? More and more people are heading to the emergency room instead of a general practitioner, according to a new study.

"Primary care is completely overwhelmed," says Dr. Stephen Pitts, lead author of the report: Where Americans Get Acute Care. "Patients have observed the fact that primary care physicians just don’t have time for unscheduled visits, and sometimes the emergency room is the only option."

The report, released Tuesday in the journal Health Affairs, analyzed more than 380,000 medical records between 2001 and 2004, and compared where people went to be treated for everything from chest pains to sinus problems.

For patients who received acute care treatment – care for sudden condition, not generally considered to be life-threatening, but that do require attention within a short period of time – less than half were treated by their own primary care physician, and emergency department visits accounted for 28 percent of the visits.

"It's quite common to call your doctor only to learn they can't fit you in for a week," says Pitts, who works in the Department of Emergency Medicine at Emory University. "Unlike at your general doctor, the emergency room works under federal law that all patients have to be seen," he says. Many of the emergency room visits for acute care cited in this report happened after hours, when primary care physicians were not in the office, and on weekends.

Dr. Angela Gardner, president of the American College of Emergency Physicians, says even acute problems can become potentially serious, so getting timely care is crucial. ACEP has helpful guidelines for determining when to go to the emergency department on its website.  But Gardner also says that most people seeking emergency care do actually need to be there, and the problem is not the patient.

"If a reasonable person would consider something an emergency, they need to go to an emergency department. You often don't know it was not urgent until after you've been checked out," Gardner says.

Both Pitts and Gardner say health care reform legislation can play a large part in alleviating the burden on the nation's emergency rooms. A poll of more than 1,800 of emergency physicians finds 73 percent are concerned about overcrowding, and other reports show increased emergency department activity paired with limited funding is impacting both patient care and the ability of some ERs to remain in business.

The authors of the Health Affairs report say a promising feature of the health reform law includes initiatives to increase the number of federally qualified community health centers, thus offering more available locations for people with acute care health problems.

"This study paints a picture of our healthcare system and points out that we just don't have the capacity to manage people who have acute care complaints," Pitts says.

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