How many people are not able to get urgent care as quickly as wanted?

In 2002, the proportion of people who sometimes or never were able to get urgent care as quickly as they (or their parent) thought necessary ranged from 8 percent of children to 19 percent of young adults. By type of coverage, the rate ranged from 6 percent of elderly adults with Medicare and private supplemental coverage to 33 percent of uninsured nonelderly adults.

Why is this important?

Timeliness of care—defined as "minimizing unnecessary delays in getting needed care"—is one of the six aims for a 21st-century health care system espoused by the Institute of Medicine. In addition to communicating respect for the patient, timeliness of care can affect care-seeking behaviors. Greater accessibility of primary care is associated with better health outcomes (Shi et al. 2002; Starfield 1985).

• Patient and parent perceptions of the ease of making an appointment are associated with continuity of care and the decision about whether to see a primary care provider or visit an emergency room (ER) (Forrest and Starfield 1998; Galbraith et al. 2004; Sarver et al. 2002).
• Getting urgent care when needed may help prevent complications and more costly care later. Seeing one's usual care provider can prevent duplicate visits for those who would otherwise visit the ER and then require follow-up with their regular doctor (Murray and Berwick 2003).
• In one study, physicians and patients closely agreed about the need for urgent (same-day or next-day) appointments for acute problems such as wheezing in an asthma patient, an ankle injury, or a sore throat with fever (Barry et al. 2006).

Findings

In 2002, among community-dwelling individuals with an illness or injury who felt that they or their child needed care right away from an emergency room, clinic, or doctor's office:

• More than three-quarters (78%) of children were always able to get urgent care as soon as their parent thought was wanted. About one of 10 children (9%) were only sometimes or never able to get urgent care as quickly as their parent wanted—about the same rate as for elderly adults.
• Young adults were less likely than elderly adults to always get care as soon as wanted (52% v. 70%), and they were two times more likely (19% v. 9%) to only sometimes or never able to get urgent care as quickly as wanted.

Among elderly adults, the proportion who only sometimes or never got urgent care as soon as wanted ranged from 6 percent of those with Medicare plus private supplemental coverage to 17 percent of those with Medicare and other public coverage such as Medicaid. This proportion increased by 3 to 6 percentage points from 2000 to 2002 for those with Medicare only or Medicare and public coverage.

Among nonelderly adults, the proportion who only sometimes or never got urgent care as soon as wanted ranged from 14 percent of those with private coverage to 33 percent of those without any coverage. The proportion increased by 4 percentage points from 2000 to 2002 for the uninsured but decreased by 3 percentage points for those with private coverage (AHRQ 2005).

Implications

Improvements are needed to better meet expectations for timely access to urgent care for all individuals, but especially for those who lack insurance or have public coverage. Poorer ratings may reflect numerous barriers to timely care such as concern about out-of-pocket costs, inadequate number of geographically accessible providers, and language differences.

Improvement Ideas and Resources

Extending health insurance to the uninsured is the most important step to improving equitable access to health care (Hargraves and Hadley 2003).

Some physician practices are redesigning their appointment scheduling processes to reserve appointments for daily needs, thus allowing patients to see their usual physician in a timely manner when they need care (Belardi et al. 2004; Bundy et al. 2005; Murray et al. 2003).

Other interventions that experts (Berry et al. 2003) have proposed to improve accessibility and timeliness of care include:

• increasing the use of mid-level practitioners such as physician assistants and nurse practitioners;
• offering group appointments with team care;
• scheduling telephone consultations or using electronic communications (with appropriate reimbursement) to supplement face-to-face care; and
• extending after-hours (evening and weekend) care.

Measure:

Data shown were collected using questions derived from the Agency for Healthcare Research and Quality's Consumer Assessment of Health Plans (CAHPS) survey.

Limitations:

Because the survey questions are designed to measure the degree to which patients' or parents' expectations have been met, these data do not provide an objective measure of waiting times for appointments. Self-reported data are subject to potential recall bias. Parents may not be aware of appointments made by adolescents at school or teen health clinics.

Source:

Results were compiled by the Agency for Healthcare Research and Quality (AHRQ 2005) using data from the Medical Expenditure Panel Survey (MEPS), a nationally representative household interview survey of the U.S. civilian, noninstitutionalized population. For children and adolescents ages 17 and younger, questions were asked of parents on the MEPS Child Health and Preventive Care section. For adults ages 18 and older, questions were asked on the MEPS Self-Administered Questionnaire.

References:

* Indicates source of data used in the chart(s).

* AHRQ (Agency for Healthcare Research and Quality). 2005. National Healthcare Quality Report, 2005. AHRQ Publication No. 06-0018. Rockville, Md.: U.S. Department of Health and Human Services.

Barry, D. W., T. V. Melhado, K. M. Chacko et al. 2006. Patient and Physician Perceptions of Timely Access to Care. Journal of General Internal Medicine> 21 (2): 130–3.

Belardi, F. G., S. Weir, and F. W. Craig. 2004. A Controlled Trial of an Advanced Access Appointment System in a Residency Family Medicine Center. Family Medicine 36 (5): 341–5.

Berry, L. L., K. Seiders, and S. S. Wilder. 2003. Innovations in Access to Care: A Patient-Centered Approach. Annals of Internal Medicine 139 (7): 568–74.

Bundy, D. G., G. D. Randolph, M. Murray et al. 2005. Open Access in Primary Care: Results of a North Carolina Pilot Project. Pediatrics 116 (1): 82–7.

Forrest, C. B., and B. Starfield. 1998. Entry into Primary Care and Continuity: The Effects of Access. American Journal of Public Health 88 (9): 1330–6.

Galbraith, A. A., J. Semura, B. McAninch-Dake et al. 2004. Emergency Department Use and Perceived Delay in Accessing Illness Care among Children with Medicaid. Ambulatory Pediatrics 4 (6): 509–13.

Hargraves, J. L., and J. Hadley. 2003. The Contribution of Insurance Coverage and Community Resources to Reducing Racial/Ethnic Disparities in Access to Care. Health Services Research 38 (3): 809–29.

Murray, M., and D. M. Berwick. 2003. Advanced Access: Reducing Waiting and Delays in Primary Care. Journal of the American Medical Association 289 (8): 1035–40.

Murray, M., T. Bodenheimer, D. Rittenhouse et al. 2003. Improving Timely Access to Primary Care: Case Studies of the Advanced Access Model. Journal of the American Medical Association 289 (8): 1042–6.

Sarver, J. H., R. K. Cydulka, and D. W. Baker. 2002. Usual Source of Care and Nonurgent Emergency Department Use. Academic Emergency Medicine 9 (9): 916–23.

Shi, L., B. Starfield, R. Politzer et al. 2002. Primary Care, Self-Rated Health, and Reductions in Social Disparities in Health. Health Services Research 37 (3): 529–50.

Starfield, B. 1985. Effectiveness of Medical Care: Validating Clinical Wisdom. Baltimore, Md.: Johns Hopkins University Press.