Abstract 35 Adolescent Medicine I Platform, Monday, 5/3

Objective This study describes demographics, health status, health behaviors, utilization of care, and reasons for missing needed care among adolescents who report using the emergency department (ED) as their usual source of health care.

Methods We analyzed the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls, a nationally representative sample of in-school male and female adolescents in 5th through 12th grade. Adolescents reporting that their only usual source of care was the ED (n=280) were compared with those who reported using physicians' offices or clinic sources (n=5744). Chi-square and logistic regression analyses were computed using SUDAAN.

Results Overall, 4.4%, or 1.5 million adolescents nationally, reported using the ED as their usual source of health care. Boys were more likely than girls to use the ED as their usual source of care (5.5% vs. 3.8%, p<.01), as were adolescents with fewer financial resources (6.9% vs. 3.8%, p<.01) and lower levels of parent education (8.9% vs. 3.2%, p<.05). Adolescents reporting alcohol or drug use, those reporting a history of physical or sexual abuse, and those with high depression scores were all more likely to use the ED as their usual source of care than adolescents without these risk factors. Other factors associated with using the ED included not having health insurance (7.8% vs. 4.1%, p<.05), living in a rural area (6.6% vs. 4.4% for urban and 3.2% for suburban adolescents, p<.001), and African-American ethnicity (8.3% vs. 5.1% for Hispanic and 3.7% for white adolescents, p<.01). In a logistic regression model, demographic and financial factors associated with the use of the ED included male gender (OR=1.62, 95% CI: 1.21-2.17), African-American ethnicity (OR=2.56, 95% CI:1.68-3.91), having fewer financial resources (OR=1.62, 95% CI:1.13-2.33), and living in a rural area (OR=1.92, 95% CI:1.23-2.99). Adolescents who reported using the ED as their usual care source were less likely to have had a preventive care visit in the previous year (75% vs. 86%, p<.01), and were more likely to report having missed needed care (40% vs. 25%, p<.001) than those with another source of primary care. Among adolescents who reported missing needed care, those who only used the ED were more likely to report that they missed care because of financial reasons than adolescents who used other sources of care (32% vs. 21%, p<.05).

Conclusion Adolescents who use the ED as their usual source of care are often from vulnerable populations, and many have special mental or physical needs that are unlikely to be met with only ED visits. In addition, these adolescents do not receive adequate preventive care, and are likely to have missed care they needed. Creating linkages between EDs and other sources of primary care, and/or improving health insurance coverage, may help at-risk adolescents identify and use continuous, comprehensive primary care.