Use of emergency departments among working age adults with disabilities: a problem of access and service needs

Abstract

Objective: To examine the relationship between emergency department (ED) use and access to medical care and prescription medications among working age Americans with disabilities.

Data source: Pooled data from the 2006-2008 Medical Expenditure Panel Survey (MEPS), a U.S. health survey representative of community-dwelling civilians.

Study design: We compared the health and service utilization of two groups of people with disabilities to a contrast group without disability. We modeled ED visits on the basis of disability status, measures of health and health conditions, access to care, and sociodemographics.

Data extraction: These variables were aggregated from the household component, the medical condition, and event files to provide average annual estimates for the period spanning 2006-2008.

Principal findings: People with disabilities accounted for almost 40 percent of the annual visits made to U.S. EDs each year. Three key factors affect their ED use: access to regular medical care (including prescription medications), disability status, and the complexity of individuals' health profiles.

Conclusions: Given the volume of health conditions among people with disabilities, the ED will always play a role in their care. However, some ED visits could potentially be avoided if ongoing care were optimized.

Keywords: (MeSH): persons with disabilities; emergency medical services; health services accessibility.

Figure 1

Relative Distribution of Conditions across Analytic Groups Associated with the Majority of Emergency Department Visits: Pooled Annual Estimates MEPS 2006–2008Note. When describing the percentage of ED visits across groups associated with particular conditions, counts may exceed 100 percent as individuals could report more than one condition associated with an ED visit. “Injuries,” “symptoms, signs, and ill-defined conditions,” and “pregnancy” were reported in “Results” and not included in graph to improve legibility.

Figure 2

Covariate Adjusted, Weighted Mean Predicted ED Visits among Working Age Adults by Access to Medical Care, Disability Status, and Number of Chronic Conditions: Pooled Annual Estimates MEPS 2006–2008Note. Estimates are based upon a zero inflated negative binomial model of ED visits. In addition to number of chronic conditions and disability status, the model includes controls for sociodemographics, number of non-chronic health conditions, and insurance coverage status. For all three disability statuses and all four chronic condition levels, all differences between ED visits on the basis of access to medical care were significant at the p < .05 level. ADL, activities of daily living; IADL, instrumental activities of daily living.