Berks County Medical Society Medical Record Spring 2019 - 26

M e d i c a l r e c o r d f e at u r e

Barriers to Care
Affect Emergency
Department Use
by Charles F. Barbera, MD, MBA, FACEP
Chair, Department of Emergency Medicine
Reading Hospital and Medical Center

I

t is estimated that anywhere from 10 to 40% of emergency
department visits are for non-emergent conditions. The reasons
people might seek care in the emergency department for
problems one might consider routine include the following:
* Lack of access to primary care
* Limited hours of their PCP office
* Needing to work and having little opportunity to keep
appointments
* Transportation barriers
* Limited ability to pay for services
* Unmet social needs
We know that a future healthcare system, in order to be
viable, requires that every patient have access to primary care.
Unfortunately, this is not the current situation in Berks County
or anywhere else in the United States. Nationally, emergency
department visits are increasing. There are many reasons for this,
which include people living longer, a greater push towards treating
chronic diseases as an outpatient and greater complexity of medical
care. This year the Reading Hospital Emergency Department will
evaluate nearly 140,000 patients, making it the highest volume
emergency department in Pennsylvania and one of the largest in the
country. Our Emergency department has over 120 beds; the average
United States hospital has 150 beds.
Nationally, it takes an average of 24 days to get an appointment
with a provider as a new patient. This wait time can be up to 30%
greater if the patient is insured under a medical assistance program.
We know that not all physicians in our community currently
accept all government sponsored insurance; this is a pattern we see
throughout the state. So whether you are privately, publicly or not
insured, you can have difficulty getting in to see a physician in a
timely fashion.
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Another contributing factor is the reality that many people
are required to work to support themselves and their families.
Employees cannot always take a day off to get to the physician
during business hours and not all physicians can accommodate
patients during off hours. The ED, on the other hand, is available to
meet their needs 24/7. Lack of access to convenient transportation
is another barrier many people face in trying to access medical care.
For those who cannot physically get to their physician's office, using
an ambulance to get to the hospital may be the only option. Services
like UBER and LYFT can help get some people to appointments,
but many times patients who lack transportation will miss their
primary care appointments, resulting in disease progression to the
point of crisis. Then they will require emergent admission to the
hospital. They will be sicker and require more intensive and costly
interventions that could have been avoided if access to primary care
had not been so difficult.
Reading Hospital instituted our Community Paramedicine
program several years ago. Under this program we identify those
patients most at risk for a hospital readmission and arrange for
a community paramedic to visit them weekly in their homes.
Patients call the community paramedic prior to coming to the
ED, and the medic will evaluate them. More often than not,
the result is avoidance of an unnecessary ED visit. The cadre of
patients served by this program has decreased ED utilization and
hospital admissions by over 50%. The community medics also
address patients' unmet social needs in areas such as food, housing,
transportation and access to medication.
Use of Emergency Departments for non-emergent medical
care reflects the failure of our current health care system to make
primary care accessible to some of the most vulnerable people in our
communities. We are fortunate to have a variety of organizations
doing good work in Berks County to address this important
problem.


http://www.berkscms.org

Berks County Medical Society Medical Record Spring 2019

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