The effect of the doctor-patient relationship on emergency department use among the elderly

Objectives. This study sought to determine the rate of emergency department use among the elderly and examined whether that use is reduced if the pati ent has a principal-care physician. Methods. The Health Care Financing Administration's National Claims History File was used to study emergency department use by Medicare patients older than 65 years in Washington State during 1994. Results. A total of 18.1% of patients had 1 or more emergency department vi sits during the study year; the rate increased with age and illness severit y. Patients with principal-care physicians were much less likely to use the emergency department for every category of disease severity. After case mi x, Medicaid eligibility, and rural/urban residence were controlled for, the odds ratio for having any emergency department visit was 0.47 for patients with a generalist principal-care physician and 0.58 for patients with a sp ecialist principal-care physician. Conclusions. The rate of emergency department use among the elderly is subs tantial, and most visits are for serious medical problems. The presence of a continuous relationship with a physician-regardless of specialty-may redu ce emergency department use.