PRIMARY-CARE PHYSICIAN ACCESS AND GATEKEEPING - A KEY TO REDUCING EMERGENCY DEPARTMENT USE

Use of the Emergency Department (ED) for nonurgent conditions results in increased cost and discontinuous health care. This prospective stud y evaluated a program (KenPAC) that required 24-hour access to a prima ry care physician (PCP) with ED gatekeeping responsibility. Following established criteria, medical records were reviewed for appropriatenes s of ED use by an urban indigent pediatric population. Emergency Depar tment visits declined (10% to 7.6% (P=0.00005) and inappropriate visit s dropped (41% to 8%) (P<0.00001) before KenPAC and after KenPAC, resp ectively. Parental experience, as judged by age and number of children , played a significant role in ED use. The institution of gatekeeping activity contributed to the reduced overall and inappropriate use of t he ED.