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 More than 10 percent of emergency department (ED) visits are for
ailments that could be treated outside the ED, which would help cut
down on crowding that can compromise the care of patients with real
emergencies, the study team writes in Annals of Emergency Medicine.
People use the ED for many reasons, including serious issues like
heart attack, strokes and injuries, said lead author Grant Martsolf
of RAND Corporation in Pittsburgh, Pennsylvania.
“Others, instead, use EDs more like primary care providers for more
minor conditions such as ear infections and coughs and colds. These
minor conditions are those that might be better treated at less
expensive locations such as a retail clinic,” Martsolf told Reuters
Health by email.
Store clinics offer support for minor medical issues and tend to
have flexible hours, lower wait times and accept most insurance
types, the researchers write.
Between 2006 and 2012, the number of retail clinics in pharmacies,
big box stores and stand-alone “urgent care” facilities rose from
130 to nearly 1,400, the authors write.
To explore how the availability of these clinics affected nearby
emergency rooms, the study team analyzed data on visits to 2,053 EDs
in 23 states between 2007 and 2012.
In particular, the researchers looked at visits to the ED for minor
complaints that could be treated at clinics, such as bronchitis,
pink eye, flu, ear infections, sore throats, urinary tract
infections and viral infections.
They also looked at how much of the local area served by each
emergency room was within a 10-minute drive of a retail clinic.
Over the five-year study period, the proportion of EDs that were
within quick driving distance of retail clinics doubled from 8
percent to 16 percent.
By 2012, however, 56 percent of emergency rooms were still not
within a 10-minute drive of a clinic.
At the start of the study, about 13 percent of emergency room visits
were for minor conditions.
Overall, having more retail clinics open nearby was not linked to a
decrease in people coming to the emergency room with minor
complaints, compared with areas that did not gain more clinics.
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During the study period, ED visits for minor issues decreased
slightly among people with private insurance, but not among
uninsured people or those receiving Medicaid or Medicare.
“Emergency room overcrowding is a real problem,” said Amer Kaissi, a
professor at Trinity University in Texas who was not involved in the
study.
“For many people, when they have a minor but nagging condition in
the evening or on the weekend, the only choice may be the emergency
room,” Kaissi said by email.
This overcrowding can cause issues when doctors and nurses are
unable to care for people who need serious help like those in car
accidents or with heart attacks, Kaissi noted.
Kaissi added that the costs for patients being treated in the ED are
also much higher than at clinics, even for the same conditions.
Although the quality of care in clinics is similar to care from a
primary doctor, Martsolf noted, “contrary to what many have hoped,
retail clinics have not reduced ED use for minor ailments.”
Kaissi recommends that people choose carefully where to go for
medical help. “If you have a minor condition you can go to the
retail clinic, but if you have a serious disease you should see your
doctor, and if you have a life-threatening condition, you should go
to the hospital’s emergency room.”
SOURCE: bit.ly/2fCxGAe Annals of Emergency Medicine, online November
10, 2016.
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