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Keywords

Emergency Department Use; Health Disparities; Medical Home; Patient Perspective; Qualitative Research Methodology

Abstract

Background

Inappropriate emergency department (ED) use continues to plague healthcare in terms of disease management and costs. In 2012, the State of Illinois implemented Medical Home Network (MHN) where Medicaid recipients were assigned to primary care providers to, in part, reduce overreliance on EDs. However, MHN patients have continued to use EDs.

Objective

The purpose of this study is to provide a qualitative analysis of Medicaid patient-identified barriers to primary care, facilitators of emergency use, and related mental health and psychosocial factors.

Methods

Patients who presented themselves at the ED located at an urban, academic medical center participated in one-time, individual interviews. Participants arrived with non-urgent, minor, or moderate acuity. Interviews were digitally audiorecorded and transcribed for data analysis. Researchers analyzed data using the Grounded Theory approach.

Results

Four themes were identified: 1) barriers related to visiting a primary care provider (not having an appointment and scheduling issues), 2) elements of ED use (the experience of physical pain), 3) mental health and stress (a lack of willingness to discuss mental health issues), and 4) varying perceptions of primary care and the ED (the ED provides care that is fast, solution-oriented, team-based, and patient-centered within an environment containing necessary equipment).

Conclusions

Findings may inform interventions such as the use of community health workers as liaisons between MHN, the ED, primary care, and patients. Addressing patient perceptions regarding the role of primary care and stigma surrounding mental health can lead to decreasing ED use and increasing continuous primary care use for vulnerable patients.