American Journal of Public Health, Vol 90, Issue 1 97-102, Copyright © 2000 by American Public Health Association

JOURNAL ARTICLE

The effect of the doctor-patient relationship on emergency department use among the elderly

RA Rosenblatt, GE Wright, LM Baldwin, L Chan, P Clitherow, FM Chen and LG Hart
Department of Family Medicine, University of Washington School of Medicine, Seattle 98195-4696, USA. rosenb@u.washington.edu

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.

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