The Effect of the Doctor-Patient Relationship on Emergency Department Use Among the Elderly

Am J Public Health. 2000 Jan;90(1):97-102. doi: 10.2105/ajph.90.1.97.

Abstract

Objectives: This study sought to determine the rate of emergency department use among the elderly and examined whether that use is reduced if the patient has a principal-care physician.

Methods: The Health Care Financing Administration's National Claims History File was used to study emergency department use by Medicare patients older than 65 years in Washington State during 1994.

Results: A total of 18.1% of patients had 1 or more emergency department visits during the study year; the rate increased with age and illness severity. Patients with principal-care physicians were much less likely to use the emergency department for every category of disease severity. After case mix, Medicaid eligibility, and rural/urban residence were controlled for, the odds ratio for having any emergency department visit was 0.47 for patients with a generalist principal-care physician and 0.58 for patients with a specialist principal-care physician.

Conclusions: The rate of emergency department use among the elderly is substantial, and most visits are for serious medical problems. The presence of a continuous relationship with a physician--regardless of specialty--may reduce emergency department use.

Publication types

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

MeSH terms

  • Aged
  • Aged, 80 and over
  • Diagnosis-Related Groups
  • Emergency Service, Hospital / statistics & numerical data*
  • Family Practice
  • Female
  • Health Services Misuse / statistics & numerical data*
  • Humans
  • Logistic Models
  • Male
  • Medicine
  • Odds Ratio
  • Physician-Patient Relations*
  • Severity of Illness Index
  • Specialization
  • Washington