Many Uninsured have been found to use the emergency department for minor medical needs that could have been cared for in outpatient clinics.

New findings by Johns Hopkins researchers find that some trauma patients who have been discharged from the hospital use the emergency department for follow-up care, even for such minor needs as pain medication refills and dressing changes, reported in the journal Annals of Emergency Medicine.

Researchers say that patients with Medicaid, Medicare and those with no insurance were 60 percent more likely to seek such care in the ED. Those living in poor areas were 70 percent more likely than patients with insurance to head to the ED instead of going to a doctor’s office or clinic.

The study suggests that for reason not well understood many patients won't or can't seek less expensive outpatient care. Researchers point out these patients end up receiving far more costly care, with longer waits and add to the crowding that burdens many of the ED.

"Just providing patients access to doctors outside of the ER clearly isn't working, especially for those without insurance," says study leader Adil H. Haider, M.D., M.P.H., an assistant professor of surgery at the Johns Hopkins University School of Medicine. "We need better ways to help patients discharged from the hospital receive appropriate follow-up care."

Analyzing records of 6,675 trauma patients admitted to the John Hopkins Hospital from 1997-2007, around 13 percent returned to the ED within a month of discharge, yet nearly 90 percent were not readmitted into the hospital, suggesting the ED visits was avoidable and would have been better served in an outpatient clinic.

The nature of the injury made no difference, those with penetrating injury like stabbing or gunshot founds, were no more or less likely to seek repeat care in the ER than those with blunt trauma injuries, like sustained in car crashes.

All trauma patients at Johns Hopkins receive a free follow up appointment, regardless of insurance, thus access to care shouldn't be an issue even for those who have no insurance and are too poor to afford private care.

"Clearly, there are more factors at play than just having an appointment or access to care," says Haider, who is also co-director of Johns Hopkins' Center for Surgery Trials and Outcomes Research.

Some of the poorest patients may find it hard to believe there is no up-front cost, and they may know they won't have to pay before being seen at the ED. Another possible factor, the researchers add, might be that clinic appointment times are inconvenient for those who cannot take time off work or who have no transportation.

"It may be that going to the ER, typically considered the provider of last resort, is the easiest option," Haider says "Improving follow-up care for these vulnerable patients will not only improve the quality of their care, but will also ease the burden on already strained emergency departments and reduce overall healthcare costs."