People who receive primary care from free clinics are less likely to use the emergency department for minor issues, according to a team of medical researchers.

Nationally, the number of emergency departments (EDs) has decreased yet the number of ED visits has gone up, the team reported. Therefore, it is important to figure out how to reduce unnecessary ED visits.

According to the National Association of Free and Charitable Clinics, there are more than 1,200 free clinics nationwide. Many of these clinics work in co-operation with one of their local hospitals.

Wenke Hwang, associate professor of public health sciences at Penn State College of Medicine, and his colleagues analysed records of uninsured patients from five hospitals and four free clinics across neighbouring Virginia communities.

Over three years, 52,010 individual uninsured patients visited at least one of the hospitals’ five emergency departments a total of 99,576 times. The researchers found that approximately 10 percent of those ED visits were by patients who had been treated at free clinics associated with the hospitals in the first two years studied

Hwang compared the diagnoses at the time of admittance to the emergency department between the free clinic patients and the non-free clinic patients. The five most common diagnoses were identical for both groups — sprains and strains, disorders of teeth and jaw, superficial injury or contusion, abdominal pain and back problems. The secondary diagnoses were not as similar for the two groups, but the researchers found mental health and substance abuse to be the most common underlying condition for both groups of uninsured patients.

‘Emergency department visits by free clinic patients were less likely to require the lowest levels of care, suggesting uninsured free clinic users were less likely to use the emergency department as their primary care provider,’ the researchers wrote.

The researchers determined that half of the ED visits in this study were avoidable, using the measurements the hospitals themselves use. By providing primary care for the uninsured, free clinics are able to help reduce non-emergency visits to the ED.

‘The emergency department is an extremely expensive and inefficient way to handle many problems that show up there,’ said Hwang. ‘If hospitals support local free clinics, the ED will be less crowded and therefore have less need for expensive expansions. Free clinics are the cheaper solution.’ Penn State University

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Advances in electronic medical record systems and health information exchange are shifting efforts in public health toward greater use of information systems to automate disease surveillance, but a study from the Regenstrief Institute has found that these technologies’ capabilities are under-utilised by those on the front lines of preventing and reporting infections.

The new study measured the awareness, adoption and use of electronic medical record systems and health information exchange by hospital-based infection preventionists (formerly known as infection control professionals) to report and share information critical to public health. Infection preventionists are often responsible for reporting information on patients diagnosed with health-care-acquired infections like Methicillin-resistant Staphylococcus aureus, or MRSA, as well as sexually transmitted diseases such as chlamydia.

Prior research at Regenstrief and other academic institutions has shown that health information exchange can increase the completeness and timeliness of infection reporting to local and state health agencies. In this study, the researchers found that half of the infection preventionists surveyed were unaware of whether their hospital or health system participated in a health information exchange. Only 10 percent of infection preventionists indicated that their organisations were formally engaged in health information exchange activities.

While 70 percent of infection preventionists surveyed reported access to an electronic medical record system, less than 20 percent were involved in the design, selection or implementation of the system. Without such involvement, those surveyed indicated the information systems often did not include modules or components that supported infection control activities.

‘There is a push from the Centers for Medicare & Medicaid Services to reduce hospital-acquired infections and increase the use of electronic health record systems,’ said lead author Brian Dixon, MPA, Ph.D., Regenstrief Institute investigator and assistant professor in the School of Informatics and Computing at Indiana University-Purdue University Indianapolis. ‘The Centers for Disease Control and Prevention are encouraging local and state health departments to use health information technologies to improve infectious disease reporting and prevention activities. We found that while hospital-based infection preventionists — the people on the front line — may have access to health information technology, they lack specially designed computer tools needed to sift through the massive amounts of data in electronic medical records.

Indiana University