The University of South Alabama Medical Center (USAMC) immediate service area (comprising the City of Prichard and the inner core of the City of Mobile) hosts a disadvantaged population of 126,130 individuals. The area’s population is predominantly African American (72%), with 31% of individuals living below poverty level. USAMC averages 28,992 Emergency Room (ER) encounters and 6,123 hospital discharges per year. An estimated 61% of Emergency Room encounters and 48% of inpatient stays at USAMC are for patients who reside in the inner core of the City of Mobile or Prichard.

Evaluation of a sample of 4,721 ER encounters at USAMC for subjects residing in the deprived area using the method devised by the New York Center for Health and Public Service Research and the United Hospital Fund of New York Emergency Department algorithm shows that only 31.9% of encounters are due to true emergencies or injuries while 32.9% of encounters are due to emergent conditions that are either primary care treatable (25.2%) or preventable/avoidable (7.7%). Close to a third (27.6) of ER encounters are due to conditions that can be classified as non-emergent. Overall, 60.5% of ER encounters at USAMC for subjects residing in the inner core of the City of Mobile or Prichard are due to conditions that could be managed in a primary care setting.

The figures quoted in he preceding paragraph provide evidence that the USAMC ER may have become the only available point of access to the health care system for a substantial proportion of vulnerable individuals who are unable to obtain health care regardless of an individual’s ability to pay. Use of the ER for non-emergent conditions places a considerable burden on the financial structure of the Hospital. Moreover, individuals who have no source of primary care usually present with severe conditions that could have been adequately managed on an ambulatory basis. The USAMC ER provides a window of access to a minority, low-income population that is obviously in need of alternative means of entry into the health care system.

Objectives

The goal of this pilot project is to identify the reasons why patients may delay seeking needed care in an ambulatory setting; i.e., identify barriers to primary care access experienced by patients coming to the USAMC. The main objectives of the project are: (1) to test an instrument to interview patients regarding access to health care, and (2) to gather preliminary data that may be used in future grant submissions for studies of barriers to primary health care among disadvantaged populations.