1. PERCENT HAVE USED URGENT CARE
Analysis of Patient Preference for Location of Care
Alexander Kowalski D.O., Alison Mancuso D.O., Rebecca Moore D.O.
Rowan University School of Osteopathic Medicine – Department of Family Medicine – Stratford, NJ
FIGURE 1: CONTRIBUTING FACTORS IN CHOOSING LOCATION OF CARE
Background/Hypothesis: Patients utilize a variety of care settings based on their perceived needs and care availability. Understanding the factors that lead to selection of this care and perceptions of quality of care is important in understanding health care utilization. It was hypothesized that patients will express a preference for receiving care in a primary care setting and the quality of this care will be rated highest, however appointment availability and after-hours care will lead to higher utilization of urgent care and emergency services.
Methods: An IRB-approved paper survey was disseminated anonymously to patients from 3 different primary care offices. Information elicited was gender, age range, insurance type, and questions regarding number of encounters and perceptions of quality of care at primary care office, urgent care, and emergency room respectively, as well as factors that lead to location of care selection.
Results: Thirty-eight surveys were analyzed. When asked to rate patient care experience and quality of care received, patients rated PCP offices highest overall in both categories (3.93 and 4.22)(p=0.4) and Urgent Care lowest in both categories (3.42 and 3.35), with the Emergency Room being in the middle ( 3.91 and 3.95) (p=0.2). Data demonstrated that Medicaid insured patients appear to utilize urgent care significantly less (0 of 7 patients) than commercially insured or Medicare insured patients (11 of 19 patients) (p=0.013). Quality and convenience were the most commonly cited factors influencing this decision.
Conclusion: This pilot study affirms that patients prefer care provided by their primary care physician based on overall experience and quality. Regardless of location of care, quality and convenience were the most important factors in selection. Low usage of urgent care by Medicaid patients is possibly based on lack of coverage of this benefit and is a potential area for utilization improvement as services provided by Urgent Care are traditionally much less costly than emergency department care for the same condition.
Acknowledgment: We acknowledge Rowan Family Medicine for their support. The study was approved by the institution’s Institutional Review Board. 1
FIGURE 2: PATIENT RATING OF QUALITY OF CARE AND EXPERIENCE BY LOCATION OF CARE
INSURANCE
PERCENT HAVE USED URGENT CARE
Private Insurance
86%
Medicare
19%
Medicaid 0%
TABLE 1: COMPARISON OF UTILIZATION BASED ON INSURANCE
REFERENCES:
1. Forman, Jane. "Established Primary Care Patients’ Preferences for Urgent Access and Continuity of Care." Research Update. University of Michigan, Ann Arbor, MI. 11 Nov Lecture. Original lecture on 7/16/2014
2. Harris, P., J. A. Whitty, E. Kendall, J. Ratcliffe, A. Wilson, P. Littlejohns, and P. A. Scuffham. "The Australian Public's Preferences for Emergency Care Alternatives and the Influence of the Presenting Context: A Discrete Choice Experiment." BMJ Open 5.4 (2015): n. pag. Web. 22 Nov
3. O’Malley, Ann S., Divya Samuel, Amelia M. Bond, and Emily Carrier. "After-Hours Care and Its Coordination with Primary Care in the U.S." J GEN INTERN MED Journal of General Internal Medicine (2012): Web. 22 Nov
4. Delia, D., J. C. Cantor, S. Brownlee, J. Nova, and D. Gaboda. "Patient Preference for Emergency Care: Can and Should It Be Changed?" Medical Care Research and Review 69.3 (2011): Web. 22 Nov .