The Patient Protection and Affordable Care Act may have provided health care insurance to an estimated 20 million Americans who lacked coverage, but it has not eased the demand on the nation’s emergency departments. In fact, since the law’s passage, reliance upon the nation’s emergency rooms for non-emergency care has increased.

ER That’s the finding of a study published online in the American Journal of Emergency Medicine by a second-year medical student at the Wayne State University School of Medicine and his colleagues.

In “Access to care issues and the role of EDs in the wake of the Affordable Care Act,” lead author Alexander Janke notes that Americans who received public insurance under the Affordable Care Act now use the emergency room more frequently than before they were insured. The overwhelming reason: Many urban and rural areas of the nation lack primary health care providers, so the emergency department becomes the only source of health care.

“Of course, we are not the first to highlight the significance of the general problem of lack of access to primary care,” said Janke, originally from Grand Rapids, Mich. “Part of the challenge is political: We need more resources in communities with many un- and underinsured, as in Detroit. Managed care approaches to health care delivery, and especially case management, have found success reducing emergency department utilization for high-frequency users. The Patient Centered Medical Home is a great example of an innovative care delivery model that makes primary care relevant to patients, high-frequency emergency department users or not, who might otherwise visit the emergency department. These kinds of innovations are certainly part of the overall solution. Emergency departments, which remain very much at the front lines of this problem, can also play a role.”

“We are moving toward a more patient-centered and integrated health care system,” Janke said. “The emergency department has many desirable qualities for patients: accessibility, diagnostic testing, procedures and a full range of provider expertise. In the paper we say ‘policymakers should provide emergency departments with resources and incentives to better address the full range of their patients’ health care needs, especially as utilization picks up under the Affordable Care Act.’ Emergency departments can coordinate better referral and follow-up, and address health issues not related to patients’ acute or emergent conditions, for example, as a checkpoint in long-term hypertension management. Ultimately, though, we will need substantial financial investment to do these things. Emergency department staff already have plenty to do.”

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To read more about this survey: http://www.medicalnewstoday.com/releases/287080.php