Emergency care and primary care: A match for rural populations.

Do freestanding emergency departments improve or degrade rural healthcare delivery? Do they encourage rural populations to seek episodic care in an emergency setting instead of seeking regular, preventive primary care – leading to a deterioration of primary care in areas that need it?

Emergency physicians in Michigan propose a new healthcare delivery model for rural populations that depends on a partnership between emergency medicine and primary care, and seeks to reverse the trend of failing health in underserved parts of the country. Their proposal was published online in Annals of Emergency Medicine (Aug. 9).

“Our emergency medicine-primary care model embraces the role that emergency departments play in providing primary care in rural areas while also connecting patients to other physicians and resources in the community,” said the paper’s lead author Margaret Greenwood-Ericksen, M.D., MPH, of the Department of Emergency Medicine at the University of Michigan in Ann Arbor. “Rural hospitals can serve as a hub for emergency care, primary and preventive care, and social services for improving rural population health.”

No more walls
The paper cites Carolinas HealthCare System Anson in Wadesboro, North Carolina, as an example of a new rural hospital designed to provide both emergency and primary care.

It is a 43,000-square-foot space built around an ED and primary care clinic that share the same space. There are no walls between the ED and primary care; all patient rooms are in one bay, with staffing stations in the middle. The ED side is a 24-hour, 10-bed area with one trauma room. The primary care side has 11 rooms and an additional space for specialists, such as cardiologists, obstetricians, and endocrinologists to treat patients on a rotating basis. They average two or three inpatients a night, with a typical stay of 48 to 72 hours, primarily for observation. Acute patients are transported to larger hospitals.

An ED nurse and a physician assistant screen each patient on arrival to determine what kind of care he or she needs. The hospital employs a patient navigator and uses behavioral health and care coordination services out of their emergency medicine–primary care core. The approach moves patients who traditionally would receive episodic care in the ED into a patient-centered medical home, according to the researchers. The hospital has enrolled more than 2,500 patients into its medical home primary care system (Carolinas Primary Care).

For more information, go to http://www.annemergmed.com/article/S0196-0644(17)30788-6/fulltext