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Primary Care Access Key to Reduce Chronic Illness ED Utilization

A new report highlights primary care access disparities and ED utilization for patients with chronic illness living in New Jersey's poorest communities.

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Source: Thinkstock

By Sara Heath

- The social determinants of health are impacting primary care access, leading to a number of preventable emergency department (ED) visits among patients managing chronic illness, according to a recent analysis from the Center for Health Analytics, Research and Transformation (CHART) at the New Jersey Hospital Association.

These findings confirm that a number of social determinants of health – or factors that impact a patient’s ability to be healthy – get in the way of adequate patient care access.

Chronic disease management should primarily occur in the primary care setting, with occasional care coordination with specialty providers. The emergency department (ED), known for its high costs and long wait times, is hardly the most efficient place for chronically ill patients to receive care.

But because of numerous social barriers, the ED has emerged as a convenient option for patients, especially those living in New Jersey’s poorest zip codes. These findings underscore a need for stronger primary care and a focus on the social determinants of health.

“You can live well with a chronic condition, but that requires access to primary care, a medical home and care management,” NJHA President and CEO Cathy Bennett said in a statement. “CHART’s study zeroes in on hotspot zip codes where there are clear gaps in that level of care. These communities demand greater attention to make sure all individuals have access to the services they need.”

An analysis of medical records from nearly 3 million ED visits during 2017 revealed that patients are accessing these facilities to address a health episode associated with a chronic illness.

This is not to say patients are accessing the ED for preventive or primary care; they may be appropriately accessing the ED for an emergency situation, but that situation likely could have been mitigating had the patient been given adequate access to primary care or care coordination.

In all, 39 percent of ED visits in 2017 were in some way associated with a patient’s chronic illness. Those visits accounted for 53 percent of ED spending.

What’s more, the high rate of chronic illness ED visits were concentrated in the poorest counties in New Jersey: Cumberland, Essex, and Atlantic counties.

The statewide average chronic illness ED visits was 129.62 visits per 1,000 people, the researchers reported. In Cumberland county, that rate was nearly double at 237.29 visits per 1,000 patients. The rate was 202.15 visits per 1,000 patients in Atlantic county and 166 visits per 1,000 patients in Essex county.

Narrowing their statistics further, the researchers revealed that the three poorest zip codes – Atlantic City (08401), Jersey City (07305), and Trenton (08618) – also had the highest rates of chronic condition ED visits.

The analysis revealed that race was associated with these care access disparities, noting that African Americans were adversely impacted in the primary care access category. Additionally, food security, transportation access, and unemployment rates were associated with low primary care access and high ED utilization.

The mismanagement of chronic illness can have considerable costs on communities, the researchers added. In 2016, treatments for patients with chronic illness cost the state $29.3 billion in healthcare costs and $69.5 billion in lost productivity.

“These are real, measurable impacts on our state,” said Sean Hopkins, senior vice president of CHART. “But chronic diseases also have a myriad of additional consequences on individuals and communities that are more challenging to quantify. What we do know from our research is that there is a clear relationship between social determinants of health and chronic disease cases in the ED.”

Alleviating both individuals’ healthcare burdens and lessening the strain on the ED will require addressing the social determinants of health and creating better primary care access, the researchers said.

New Jersey healthcare professionals can begin by exploring innovative healthcare delivery models that meet patients where they are, including using mobile health clinics or school-based health programs.

Additionally, granting patients access to self-management apps and remote patient monitoring will help drive better management and detect where there are potential problems.

Finally, healthcare professionals can partner with community organizations to spread public awareness about chronic care management. Patients likely know about their diagnoses, but have not been adequately educated about management and the importance of management.

Community groups that encourage self-management and primary care access could help close these care access gaps, the researchers concluded.

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