Background: Preventable ED visits account for 20-50% of ED visits. (1, 2) Though student-run free clinics (SRFCs) could play an important role in decreasing unnecessary utilization, current ED utilization in SRFCs and risk factors have not been described.
Methods: We conducted a cross-sectional study of patients receiving care at a student-run free clinic. We captured patient demographics and visit information, classified visits as “preventable” using the AHRQ definition for ambulatory sensitive conditions. We assessed for risk of ED utilization with a logistic model stratified by mental health disorder status. We adjusted for medical comorbidities, history of ED visits, and missed primary care appointments.
Results: Among the 254 patients who visited the SRFC during the one-year study period, 23.2% visited the emergency department. Patients who visited the ED were more likely to have a mental health diagnosis (49.2% vs. 28.2%), more chronic conditions (Charlson Comorbidity Index of 2 vs. 1), more missed appointments (3 vs. 2), and an ED visit in the prior year (40.7% vs. 10.8%). Only 6.3% of patients had more than one emergency department visit. Preventable visits accounted for 15.9% of ED visits, half of which were diabetes-related. The presence of a mental health disorder increased the odds of an ED visit (Odds Ratio (OR): 2.46, 95% confidence interval (CI): 1.35, 4.48). Medical comorbidities were associated with increased odds of ED utilization among those without a mental health disorder (OR: 1.28, 95% CI: 1.03, 1.61). Past history of ED visits was associated with an increased odds of ED utilization (OR: 3.75, 95% CI: 1.72, 8.16 for those with a mental health diagnosis; OR: 2.33, 95% CI: 1.13, 4.79 for those without). The proportion of missed primary care visits were not associated with a change in odds of ED utilization.
Conclusions: A substantial number of patients at one SRFC access the ER for care, the majority of which are diabetes related. Risk factors for emergency department use among patients with access to an SRFC include mental health diagnosis, multiple comorbidities, and a prior history of ED use. These results can guide future interventions at the clinic specifically targeting patients with diabetes and the identified risk factors.