Cargando…

Rural Ambulatory Access for Semi-Urgent Care and the Relationship of Distance to an Emergency Department

INTRODUCTION: Availability of timely access to ambulatory care for semi-urgent medical concerns in rural and suburban locales is unknown. Further distance to an emergency department (ED) may require rural clinics to serve as surrogate EDs in their region, and make it more likely for these clinics to...

Descripción completa

Detalles Bibliográficos
Autores principales: Parks, Ashley, Hoegh, Andy, Kuehl, Damon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530925/
https://www.ncbi.nlm.nih.gov/pubmed/26265979
http://dx.doi.org/10.5811/westjem.2015.4.25485
_version_ 1782384956583968768
author Parks, Ashley
Hoegh, Andy
Kuehl, Damon
author_facet Parks, Ashley
Hoegh, Andy
Kuehl, Damon
author_sort Parks, Ashley
collection PubMed
description INTRODUCTION: Availability of timely access to ambulatory care for semi-urgent medical concerns in rural and suburban locales is unknown. Further distance to an emergency department (ED) may require rural clinics to serve as surrogate EDs in their region, and make it more likely for these clinics to offer timely appointments. We determined the availability of urgent (within 48 hours) access to ambulatory care for non-established visiting patients, and assessed the effect of insurance and ability to pay cash on a patient’s success in scheduling an appointment in rural and suburban Eastern United States. We also assessed how proximity to EDs and urgent care (UC) facilities influenced access to semi-urgent ambulatory appointments at primary care facilities. METHODS: The Appalachian Trail, which runs from Georgia to Maine, was used as a transect to select 190 rural and suburban primary care clinics located along its entire length. We calculated their location and distance to the nearest hospital-based ED or UC via Google Earth. A sham patient representing a non-established visiting patient called each clinic over a four-month period (2013), requesting an appointment in the next 48 hours for one of three scripted clinical vignettes representing common semi-urgent ambulatory concerns. We randomized the scenarios and insurance statuses (insured vs. uninsured). Each clinic was contacted twice, once with the caller representing an insured patient, once with the caller representing an uninsured patient. When the caller was representing an uninsured patient, any required upfront payment was requested from each clinic. One hundred dollars was used as a cutoff between the uninsured as a distinction between those able to afford substantial upfront sums and those who could not. To determine if proximity to other sources of care impacted a clinic’s ability to grant an appointment, distance to the nearest ED or UC was modeled as a dichotomous variable using 30 miles as the divider. RESULTS: Of 380 requests, 96 (25.3%) resulted in appointments within 48 hours. Insured patients and uninsured patients able to pay a substantial amount upfront (>$100) were more likely to book an appointment (p-value <0.001, OR 18, CI [5–154]). Of the 47 clinics that granted uninsured patients appointments 89.3% required some form of payment up front. Farther distances from an ED did not result in greater likelihood of an appointment (OR 1.7, CI [0.4–11.3]). Clinics located within 30 miles of an UC were more likely to grant an appointment (OR 2.45, CI [1.19–5.80]). CONCLUSION: Almost 75% of rural clinics were unable to grant a new appointment for a semi-urgent health complaint. Lack of insurance and large upfront charges appear to be significant barriers to rural ambulatory care appointments. Greater distance from an ED does not improve a clinic’s ability to see semi-urgent appointments. Clinics located near an UC were more likely to grant an appointment than clinics without close alternative outpatient healthcare options.
format Online
Article
Text
id pubmed-4530925
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher Department of Emergency Medicine, University of California, Irvine School of Medicine
record_format MEDLINE/PubMed
spelling pubmed-45309252015-08-11 Rural Ambulatory Access for Semi-Urgent Care and the Relationship of Distance to an Emergency Department Parks, Ashley Hoegh, Andy Kuehl, Damon West J Emerg Med Emergency Department Access INTRODUCTION: Availability of timely access to ambulatory care for semi-urgent medical concerns in rural and suburban locales is unknown. Further distance to an emergency department (ED) may require rural clinics to serve as surrogate EDs in their region, and make it more likely for these clinics to offer timely appointments. We determined the availability of urgent (within 48 hours) access to ambulatory care for non-established visiting patients, and assessed the effect of insurance and ability to pay cash on a patient’s success in scheduling an appointment in rural and suburban Eastern United States. We also assessed how proximity to EDs and urgent care (UC) facilities influenced access to semi-urgent ambulatory appointments at primary care facilities. METHODS: The Appalachian Trail, which runs from Georgia to Maine, was used as a transect to select 190 rural and suburban primary care clinics located along its entire length. We calculated their location and distance to the nearest hospital-based ED or UC via Google Earth. A sham patient representing a non-established visiting patient called each clinic over a four-month period (2013), requesting an appointment in the next 48 hours for one of three scripted clinical vignettes representing common semi-urgent ambulatory concerns. We randomized the scenarios and insurance statuses (insured vs. uninsured). Each clinic was contacted twice, once with the caller representing an insured patient, once with the caller representing an uninsured patient. When the caller was representing an uninsured patient, any required upfront payment was requested from each clinic. One hundred dollars was used as a cutoff between the uninsured as a distinction between those able to afford substantial upfront sums and those who could not. To determine if proximity to other sources of care impacted a clinic’s ability to grant an appointment, distance to the nearest ED or UC was modeled as a dichotomous variable using 30 miles as the divider. RESULTS: Of 380 requests, 96 (25.3%) resulted in appointments within 48 hours. Insured patients and uninsured patients able to pay a substantial amount upfront (>$100) were more likely to book an appointment (p-value <0.001, OR 18, CI [5–154]). Of the 47 clinics that granted uninsured patients appointments 89.3% required some form of payment up front. Farther distances from an ED did not result in greater likelihood of an appointment (OR 1.7, CI [0.4–11.3]). Clinics located within 30 miles of an UC were more likely to grant an appointment (OR 2.45, CI [1.19–5.80]). CONCLUSION: Almost 75% of rural clinics were unable to grant a new appointment for a semi-urgent health complaint. Lack of insurance and large upfront charges appear to be significant barriers to rural ambulatory care appointments. Greater distance from an ED does not improve a clinic’s ability to see semi-urgent appointments. Clinics located near an UC were more likely to grant an appointment than clinics without close alternative outpatient healthcare options. Department of Emergency Medicine, University of California, Irvine School of Medicine 2015-07 2015-06-24 /pmc/articles/PMC4530925/ /pubmed/26265979 http://dx.doi.org/10.5811/westjem.2015.4.25485 Text en Copyright © 2015 the authors. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/.
spellingShingle Emergency Department Access
Parks, Ashley
Hoegh, Andy
Kuehl, Damon
Rural Ambulatory Access for Semi-Urgent Care and the Relationship of Distance to an Emergency Department
title Rural Ambulatory Access for Semi-Urgent Care and the Relationship of Distance to an Emergency Department
title_full Rural Ambulatory Access for Semi-Urgent Care and the Relationship of Distance to an Emergency Department
title_fullStr Rural Ambulatory Access for Semi-Urgent Care and the Relationship of Distance to an Emergency Department
title_full_unstemmed Rural Ambulatory Access for Semi-Urgent Care and the Relationship of Distance to an Emergency Department
title_short Rural Ambulatory Access for Semi-Urgent Care and the Relationship of Distance to an Emergency Department
title_sort rural ambulatory access for semi-urgent care and the relationship of distance to an emergency department
topic Emergency Department Access
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530925/
https://www.ncbi.nlm.nih.gov/pubmed/26265979
http://dx.doi.org/10.5811/westjem.2015.4.25485
work_keys_str_mv AT parksashley ruralambulatoryaccessforsemiurgentcareandtherelationshipofdistancetoanemergencydepartment
AT hoeghandy ruralambulatoryaccessforsemiurgentcareandtherelationshipofdistancetoanemergencydepartment
AT kuehldamon ruralambulatoryaccessforsemiurgentcareandtherelationshipofdistancetoanemergencydepartment