Discontinuity of care: urgent care utilization within a health maintenance organization

Am J Manag Care. 1998 Nov;4(11):1531-7.


Objective: To determine the demographic characteristics, attitudes, and perceived barriers to primary care reported by patients seen in the urgent care department of a health maintenance organization (HMO) health center.

Study design: Cross-sectional survey.

Patients and methods: Patients aged 18 years or older who sought care at the urgent care department of a large, urban health center of a staff-model HMO were eligible for the study. Patients were handed a survey as they registered in the urgent care department. Demographic and visit diagnoses data were obtained through review of the computerized medical record.

Results: Patients seeking treatment at the urgent care department were significantly younger than those seen at a primary care physician's office (mean age, 40 years versus 46 years; P < or = 0.0001) but otherwise had similar demographic characteristics. Nearly 90% of 421 patients seen in the urgent care department reported having a primary care physician. When asked to list the reasons why they came to the urgent care department instead of the primary care offices, 64% said they needed to be seen immediately, 47% came because the primary care offices were closed, 27% cited the constraints of work or childcare, and 25% said they were unable to get an appointment with their primary care physician. Almost half of patients (47%) said they would have preferred to see their primary care physician within a day or two rather than seeking care at the urgent care department.

Conclusions: Patients treated in the urgent care department reported various barriers to seeing their primary care physician. Improving same-day access to primary care providers will help alleviate this problem and may increase patient satisfaction.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Adult
  • Boston
  • Continuity of Patient Care*
  • Cross-Sectional Studies
  • Data Collection
  • Emergency Medical Services / statistics & numerical data*
  • Female
  • Health Maintenance Organizations / organization & administration*
  • Health Maintenance Organizations / statistics & numerical data
  • Health Services Accessibility
  • Health Services Research
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Primary Health Care / statistics & numerical data