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June 26, 2013

Overuse of Emergency Departments—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliation: Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (jadams@nmh.org).

JAMA. 2013;309(24):2549-2550. doi:10.1001/jama.2013.6938

In Reply: The suggestion of Mr Cowling and Dr Majeed to ensure the availability of primary care when and where the patients need it should be encouraged. As new models to increase the accessibility of primary care services are developed and evaluated, policy makers must be careful to avoid a priori assumptions that EDs are overused and misused because of poor decisions on the part of patients.

The reasons people visit the ED for care are often rational and understandable, driven by a perceived need for immediacy of treatment and lack of an accessible alternative.1 Many conditions treatable in primary care that are cared for inside EDs in the United States may reflect problems with alternative access to rather than inappropriate actions by the patient.2

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