Sixty-four percent of ED directors expressed concern that preventive services would increase patients' length of stay, leading to overcrowding.
While three-quarters of ED directors surveyed do not oppose offering preventive services, the same number worries that doing so could financially hurt their departments. The government and insurance companies do not reimburse emergency departments for the cost of most preventive services, Delgado said. "Our findings imply that more widespread dissemination of ED preventive services will likely be contingent on improved reimbursement," the authors write in the study.
Delgado referred to recent reports in the Journal of the American Medical Association and from the U.S. Department of Health and Human Services that find patients with poor access to primary care, even those with insurance, are the largest rising segment of the patient population showing up at EDs.
Unsurprisingly, a system to link emergency department patients with primary care providers topped the wish list among directors, followed closely by a system to cover uninsured patients with some form of medical insurance.
The authors conclude that more research is needed on the cost-effectiveness of ED preventive services, as well as on their effect on patient flow, to help determine the best way to invest ED resources.
Ultimately, however, emergency departments are not well-designed for providing preventive care, Delgado said.
"The goal for health-care reform should go beyond increasing access to health insurance to ensuring that primary care is actually accessible," he said. "This would free up ED resources to handle rising volumes of patients for acute care visits and would ensure that benefits from prevention efforts are sustained over the long run."
|Contact: John Sanford|
Stanford University Medical Center