Free clinic patients less likely to use ED for minor issues

Penn StateJan 23 2013

People who receive primary care from free clinics are less likely to use the emergency department for minor issues, according to a team of medical researchers.

Nationally, the number of emergency departments (EDs) has decreased yet the number of ED visits has gone up, the team reported. Therefore, it is important to figure out how to reduce unnecessary ED visits.

According to the National Association of Free and Charitable Clinics, there are more than 1,200 free clinics nationwide. Many of these clinics work in cooperation with one of their local hospitals.

Wenke Hwang, associate professor of public health sciences at Penn State College of Medicine, and his colleagues analyzed records of uninsured patients from five hospitals and four free clinics across neighboring Virginia communities.

Over three years, 52,010 individual uninsured patients visited at least one of the hospitals' five emergency departments a total of 99,576 times. The researchers found that approximately 10 percent of those ED visits were by patients who had been treated at free clinics associated with the hospitals in the first two years studied. Their results are reported in a recent article in the Journal of Health Care for the Poor and Underserved.

Hwang compared the diagnoses at the time of admittance to the emergency department between the free clinic patients and the non-free clinic patients. The five most common diagnoses were identical for both groups -- sprains and strains, disorders of teeth and jaw, superficial injury or contusion, abdominal pain and back problems. The secondary diagnoses were not as similar for the two groups, but the researchers found mental health and substance abuse to be the most common underlying condition for both groups of uninsured patients.

"Emergency department visits by free clinic patients were less likely to require the lowest levels of care, suggesting uninsured free clinic users were less likely to use the emergency department as their primary care provider," the researchers wrote.

The researchers determined that half of the ED visits in this study were avoidable, using the measurements the hospitals themselves use. By providing primary care for the uninsured, free clinics are able to help reduce non-emergency visits to the ED.

"The emergency department is an extremely expensive and inefficient way to handle many problems that show up there," said Hwang. "If hospitals support local free clinics, the ED will be less crowded and therefore have less need for expensive expansions. Free clinics are the cheaper solution."