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Emergency Department Utilization among Underserved African American Older Adults in South Los Angeles

1
Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
2
Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
3
School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA
4
Department of Pharmacy Practice, West Coast University, Los Angeles, CA 90004, USA
5
Department of public health, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA
6
Department of Emergency Medicine, UC Davis Medical Center, University of California, Davis, Sacramento, CA 95817, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(7), 1175; https://doi.org/10.3390/ijerph16071175
Received: 20 February 2019 / Revised: 21 March 2019 / Accepted: 1 April 2019 / Published: 2 April 2019
(This article belongs to the Special Issue Efficient Use of Acute Hospital Services for Older People)
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PDF [341 KB, uploaded 2 April 2019]

Abstract

Objectives: Using the Andersen’s Behavioral Model of Health Services Use, we explored social, behavioral, and health factors that are associated with emergency department (ED) utilization among underserved African American (AA) older adults in one of the most economically disadvantaged urban areas in South Los Angeles, California. Methods: This cross-sectional study recruited a convenience sample of 609 non-institutionalized AA older adults (age ≥ 65 years) from South Los Angeles, California. Participants were interviewed for demographic factors, self-rated health, chronic medication conditions (CMCs), pain, depressive symptoms, access to care, and continuity of care. Outcomes included 1 or 2+ ED visits in the last 12 months. Polynomial regression was used for data analysis. Results: Almost 41% of participants were treated at an ED during the last 12 months. In all, 27% of participants attended an ED once and 14% two or more times. Half of those with 6+ chronic conditions reported being treated at an ED once; one quarter at least twice. Factors that predicted no ED visit were male gender (OR = 0.50, 95% CI = 0.29–0.85), higher continuity of medical care (OR = 1.55, 95% CI = 1.04–2.31), individuals with two CMCs or less (OR = 2.61 (1.03–6.59), second tertile of pain severity (OR = 2.80, 95% CI = 1.36–5.73). Factors that predicted only one ED visit were male gender (OR = 0.45, 95% CI = 0.25–0.82), higher continuity of medical care (OR = 1.39, 95% CI = 1.01–2.15) and second tertile of pain severity (OR = 2.42, 95% CI = 1.13–5.19). Conclusions: This study documented that a lack of continuity of care for individuals with multiple chronic conditions leads to a higher rate of ED presentations. The results are significant given that ED visits may contribute to health disparities among AA older adults. Future research should examine whether case management decreases ED utilization among underserved AA older adults with multiple chronic conditions and/or severe pain. To explore the generalizability of these findings, the study should be repeated in other settings. View Full-Text
Keywords: emergency department utilization; African Americans; older adults emergency department utilization; African Americans; older adults
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Bazargan, M.; Smith, J.L.; Cobb, S.; Barkley, L.; Wisseh, C.; Ngula, E.; Thomas, R.J.; Assari, S. Emergency Department Utilization among Underserved African American Older Adults in South Los Angeles. Int. J. Environ. Res. Public Health 2019, 16, 1175.

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