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December 12, 2012

Sue Ducat
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From Health Affairs


Patients with After-Hours Access to Their Providers Showed Lower Emergency Room Use


Bethesda, MD -- The first study to use a nationally representative sample to describe after-hours care in the US, being released today as a Web First by Health Affairs, demonstrated that emergency room usage is significantly lower when patients have access to after-hours services with their primary care provider. According to the study, 30.4 percent of patients with after-hours access to their primary care providers reported emergency room use, compared to 37.7 percent of those lacking after-hours access. Another key finding: patients with access to after-hours care reported a significantly lower rate of unmet medical need: 6.1 percent versus 13.7 percent of those lacking after-hours access.



After-Hours Access To Primary Care Practices Linked With Lower Emergency Department Use And Presence Of Less Unmet Medical Need


By Ann S. O'Malley


O'Malley is a senior fellow at the Center for Studying Health System Change in Washington, D.C.


The study, also to appear in the journal's January issue, was supported by the National Institute for Health Care Reform. The Robert Wood Johnson Foundation funded the survey.

The findings come from the 2010 Health Tracking Household Survey by the Center for Studying Health System Change. The total sample included 9,577 respondents, of which 40.2 percent reported that their providers' practice offered after-hours (evening and weekend) office visits. Of the total sample with a usual primary care provider, 1,470 had attempted to contact their usual provider after-hours within the past twelve months by some means, including phone, electronic or actual visits. Of those trying to access after-hours care, children (through a parent or other adult) had the highest rate of contacting their provider. Less healthy adults and those lacking private insurance, reported more difficulty accessing their provider after hours than other respondents.


"Increased support for primary care practices to provide or arrange for accessible after-hours care (by phone, by e-mail, or in person) has the potential to reduce rates of emergency department use," concluded the author. "When primary care providers deliver more accessible care after hours and avoid potentially unnecessary emergency department visits, decreasing overall costs to the system, the current fee-for-service system does not reward them. It is hoped that future payment reform under patient-centered medical homes and bundled payments may begin to address these issues."

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically and health policy briefs published twice monthly at You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download weekly Narrative Matters podcasts on iTunes.

The full text of each Health Affairs Web First paper is available free of charge to all Web-site visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund.