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ACEP: “Following Up With A PCP Isn’t So Easy …”

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Contact:  Elaine Salter
Twitter @emergencydocs

For Immediate Release:  October 13, 2017

Following Up with A Primary Care Physician Isn’t So Easy 

WASHINGTON — Patients discharged from the emergency department with instructions to follow up with primary care within 7 days were only able to do so 30 percent of the time on average, and even less if they had Medicaid, according to the results of a “secret shopper” study published online today in Annals of Emergency Medicine (“Insurance Status and Access to Urgent Primary Care Follow-Up After an Emergency Department Visit in 2016”). 

“Follow-up is an essential continuation of the outpatient care provided by emergency departments,” said lead study author Shih-Chuan Chou, MD, MPH, of the Yale School of Medicine in New Haven, Conn. “As an emergency physician, I routinely ask patients to follow-up with a primary care physician in a week for further care. However, our study showed that it is surprisingly difficult for patients who don’t already have a primary care physician to secure a timely follow-up appointment after an ER visit, especially if they have Medicaid.”

Two local community members, both African-American males, posed as new patients discharged from the emergency department requesting follow-up appointments with primary care physicians. Using a variety of scripts, these “secret shoppers” posed as patients with different types of insurance and one of two conditions: hypertension and back pain.

The overall 7-day appointment rate was 30.7 percent. For Medicaid patients, the 7-day appointment rate was 25.5 percent; for privately insured patients, the 7-day appointment rate was 35.7 percent. When the secret shoppers called for follow-up due to back pain, they were able to get appointments within 7 days only 27.6 percent of the time, versus when calling for hypertension (33.7 percent of the time).

“In debriefing, our callers reported that back pain phone calls consistently led to more questions, particularly regarding medication use,” said Dr. Chou. “A couple of the offices even said they don’t see back pain patients, possibly due to negative stigmas associated with the condition, such as opiate-seeking. In the real world, after an ER evaluation, patients who want to establish ongoing care for back pain or hypertension or anything else may not be able to wait 7 or more days.”

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information, visit

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