Emergency departments are frequently used by young adults

by Kristina Fiore

Twenty-somethings rely on emergency departments (EDs) for care far more than do other age groups, researchers have found.

In 2006, nearly a quarter of all young adult healthcare visits — 22.1% — took place at an ED, compared with 12.6% for children and adolescents and 8.3% for patients over 30.

That rate has significantly increased over a 10-year period, Robert J. Fortuna, MD, MPH, of the University of Rochester Medical Center, and colleagues reported online in the Journal of General Internal Medicine.

“A considerable amount of care provided to young adults in the U.S. is delivered through emergency departments,” the researchers wrote. “Trends further suggest that young adults are increasingly relying on emergency departments for healthcare while being seen for less urgent indications.”

What’s more, this is occurring at a time when EDs are increasingly overburdened, they added.

It has been reported that 20-somethings overuse emergency care, frequently because they are the age group most likely to lack health insurance, and to lose their insurance during this transition from adolescence and adulthood.

They are also the leading age group for many types of risky behaviors, including substance abuse, sexually transmitted infections, homicide, and car accidents.

So, to characterize emergency to young adults, the researchers conducted a cross-sectional analysis of data from 17,048 ED visits and 14,443 outpatient visits by patients in the National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey.

The researchers found that between 1996 and 2006, ED visits by patients ages 20 to 29 increased by 5.5 million, rising to 22.1% of all healthcare visits among this age group (up from 19.1%) in 1996 (P<0.001).

The 2006 figures compare with 12.6% of visits by children and adolescents, and 8.3% for patients ages 30 and over.

“This finding likely represents a combination of relative overutilization of emergency services and underutilization of primary care,” the researchers wrote.

Twenty-somethings were more likely to be cared for in EDs for both injury-related and noninjury related problems than any other age group (P<0.001).

Just 19.4% of young adult visits were injury-related, and the majority of cases weren’t of an urgent nature, the researchers said. Less than 5% of 20-somethings were admitted to the hospital following treatment.

Their visits were half as likely as other age groups to be triaged as immediate or emergent (P<0.001).

This suggests that a good portion of their care could have been done in an outpatient clinic instead, the researchers wrote.

They also found that black patients received a disproportionate amount of healthcare in EDs — considerably more than white 20-somethings (36.2% versus 19.2%, P<0.001). In 2006, nearly half (48.5%) of all healthcare provided to young black men was delivered through emergency departments.

The researchers said the increase may result from barriers in access to primary care, disparities in preventive services, or inequalities in health education.

Fortuna said that new provisions in the healthcare reform act “are encouraging for young adults.”

“Currently, young adults are the most likely age group to be uninsured and have the highest rates of many preventable conditions,” he said in an e-mail to MedPage Today. “The possibility to extend coverage for many young adults until the age of 26 is an important step towards improving health for young adults.”

Future initiatives to reduce overburdening EDs, Fortuna said, should focus on improving primary care for young adults.

“Access to a usual source of primary care is associated with improved overall health outcomes and lower rates of preventable ED use,” he said in a statement.

“Improving health access for young adults will require a multifaceted approach to expand healthcare coverage, improve transition between adolescent and adult care, and increase overall awareness of the importance for young adults to establish a usual source of care.”

The authors noted that their study was limited because the databases used may underestimate ambulatory care and overestimate ED visits.

Kristina Fiore is a MedPage Today staff writer.

Originally published in MedPage Today. Visit MedPageToday.com for more emergency medicine news.