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Abstract

The objectives of this article are: First, to determine the rate of referral completions for primary care physicians (PCPs) given out in the emergency department (ED) to the patients who are present without a PCP. The second objective is to determine the reasons given by the individuals who did not use the referrals given.

The methods used during this article are: A retrospective study looking at who uses the referrals given to them in the ED during a six month ED-based pilot programme. A second prospective study using a phone survey was then done; those who did not use the referrals were contacted, which helped in determining the reasons for the non-usage. The study was approved by the Institutional Review Board (IRB).

The results of this article indicate that there was a significant difference based on gender (p = 0.001). Males, who made up 48 per cent of the total survey population, used referrals only 9 per cent of the time as compared to females. Females, at 52 per cent of the total respondents, used referrals 42 per cent of the time. There was also a significant difference (p = 0.01) based on method of payment for services. The type of payment was mixed, with 51 per cent self-pay, 30 per cent public and 18 per cent private. Those in the category of self-pay had 43 per cent non-usage as compared to 30 per cent of those with public and 7 per cent of the private payers. There was no significant difference based on the type of illness, age and/or education. The reasons given for not using referrals were: 25 per cent did not remember being given a referral; 14 per cent did not speak English well enough to understand referrals; for 10 per cent the location was inconvenient; and 10 per cent reported improvement in health condition.

The usage of referrals was affected by several factors. It was affected by the insurance status, despite the patient being told that the health care provider was free of charge. The second factor was gender, with females being more likely to use the referrals given. The reasons given for non-usage were also multidimensional, with the largest percentage (25 per cent) not remembering that they were given referrals in the ED, 14 per cent having language barriers that affected use, 10 per cent finding the location difficult to reach and 10 per cent stating their condition had improved, thus not needing the referral.

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Rate of Use of Referrals in the Emergency Department

Abstract

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