Adolescents who use the emergency department as their usual source of care

Objective: To examine the factors associated with use of the emergency depa rtment (ED) as the only source of health care among adolescents. Design: Analyses of the 1997 Commonwealth Fund Survey of the Health of Adol escent Girls, a nationally representative sample of 6748 in-school male and female adolescents in 5th through 12th grade. The chi(2) statistics and lo gistic regression analyses were computed with the use of SUDAAN. Results: Overall, 4.6% of the adolescents in the survey, or 1.5 million ado lescents in the United States, reported that the ED was their usual source of health care. In multivariate models, factors associated with the use of the ED included male sex, African American ethnicity, fewer financial resou rces, and living in a rural area. Adolescents with higher levels of risky b ehaviors, a history of physical or sexual abuse, and higher depression scor es were all more likely to use the ED as their usual source of care. Adoles cents who reported using the ED as their usual care source were also less l ikely to have had regular well visits and were more likely to report having missed needed care than those with other sources of primary care. Conclusions: Adolescents who use the ED as their usual source of care are o ften from vulnerable populations. Many have special mental or physical need s that are unlikely to be met with ED visits only, and they are likely to h ave missed care they needed. Creating linkages between EDs and other sen ic es could help at-risk adolescents identify and use more appropriate sources of primary care.