Here is something that anyone with a child or an elderly parent could have told you: emergency room use is significantly less when patients can see their primary-care providers outside of regular office hours.

That was the conclusion of a study released this week by Health Affairs showing that patients were far less likely to use the ER when they had evening and weekend access to their physicians, and they had a significantly lower rate of unmet medical need than those who didn't have such access.

All of this falls under the heading of no brainer of course people who can get to their docs in the evenings and weekends are less like to go to the ER. But according to the journal article by Ann O'Malley, a senior fellow at the Center for Studying Health System Change, this was the first study to use a nationally representative sample to look at people's access to after-hours care and whether that was associated with emergency-room use, hospitalization, and unmet medical need. Previous research had focused on the benefits of people having a primary-care provider, but not added the piece on after-hours care.

According to O'Malley's research, only 29 percent of U.S. primary-care physicians offer after-hours care, compared to 95 percent in the United Kingdom and 94 percent in the Netherlands.
But abdominal pain, fevers, and scary, mysterious ailments occur at all hours, sending many Americans to the ER for care they could have gotten from their family doctor or internist. That, in turn, contributes to the high cost and fragmentation of healthcare in this country.

O'Malley's article reported that 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 without after-hours access. In addition, those with after-hours access had just a 6.1 percent rate of unmet medical need, compared to 13.7 percent of people who had less ready access to after-hours care.

A central tenet of the Affordable Care Act is improving access to and coordination of primary care. Numerous medical home pilots are underway that pay PCPs extra for better coordinating patients care; having written standards for patient access and patient communication is one of six must-pass elements for medical practices to be recognized as patient-centered medical homes. One way to address accessibility is through urgent-care centers and retail clinics, both of which have grown dramatically in recent years. About 300 new urgent care centers open every year, according to the Urgent Care Association, with more than 9,000 now that provide walk-in service for acute illness or injury that is not life threatening. There are also more than 1,400 retail-based clinics in locations such as Wal-Marts and CVS stores, up from just 200 in 2006.

In an effort to stave off a shortage of PCPs, the federal government is providing $250 million in new funding to train doctors, nurses, practitioners, and physician's assistants. More PCPs and nurse practitioners will help our fragmented healthcare system, but being able to access those providers outside of traditional office hours will also be important.

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