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June 22, 1994

Regular Source of Ambulatory Care and Medical Care Utilization by Patients Presenting to a Public Hospital Emergency Department

Author Affiliations

From the Division of General Internal Medicine (Dr Baker) and the Department of Emergency Medicine (Dr Stevens), the Harbor-UCLA Medical Center, Torrance, Calif; Value Health Sciences, Santa Monica, Calif (Dr Stevens); the Departments of Medicine and Health Services, UCLA Center for the Health Sciences, Los Angeles, Calif (Dr Brook); and the Health Sciences Program, RAND, Santa Monica (Dr Brook).

JAMA. 1994;271(24):1909-1912. doi:10.1001/jama.1994.03510480033030

Objective.  —To determine the regular source of care and the relationship between usual provider and use of medical services among ambulatory emergency department patients.

Design.  —Cross-sectional survey.

Setting.  —A public hospital in Los Angeles County, California.

Patients.  —A total of 1190 stable, ambulatory adults presenting to the emergency department during a 2-week period.

Main Outcome Measures.  —Self-reported regular source of care, usual health status, and recent physician visits.

Results.  —A total of 16% of the patients identified an emergency department as their regular source of care. One fourth of this group reported fair or poor health. African Americans and Latinos were more likely than whites to identify an emergency department as their regular source of care. Patients who identified an emergency department as their regular source of care had 25% fewer physician visits and were less likely to have seen a physician during the preceding 3 months than patients who were usually seen in an office or clinic (relative risk, 0.45; 95% confidence interval, 0.28 to 0.70). Of all patients, 56% identified a regular source of care other than an emergency department, but 24% to 36% of all their recent physician visits still occurred in an emergency department.

Conclusion.  —Our patients rely heavily on emergency departments for ambulatory physician visits, regardless of their reported regular source of care. However, patients who identify an emergency department as their regular source of ambulatory care used physician services less frequently than patients with access to providers in other settings. These issues require further evaluation with populationbased surveys.(JAMA. 1994;271:1909-1912)