Expansion of primary care services provided by community health centers may result in a decrease in psychiatric emergency department visits, according to research released in June.

 

Community health centers (CHCs) represent a federal government effort to increase access to health care for low-income, underserved communities. CHCs provide both primary care and preventive services such as health screenings and management of chronic conditions, and currently serve more than 28 million Americans across the country. CHCs also deliver a number of additional services to facilitate care for the populations they serve, including transportation to and from clinics for appointments, translation for those who speak other languages, and health education on chronic disease management and wellness.

 

One key metric for CHCs in providing cost-efficient care is the reduction of avoidable emergency department (ED) visits. For individuals without regular access to primary care, the ED can serve as a costly last-resort when conditions have been left untreated. This reality is especially problematic for individuals with mental illness, whose undiagnosed or inadequately managed symptoms can culminate in a psychiatric crisis, from which recovery may be more difficult. EDs are also particularly ill-suited for treating chronic conditions such as mental illness that often require the expertise of a specialist with an eye toward long-term care.

 

Utilizing data from a nationwide reporting system for CHCs and the State Emergency Department Database, a team of researchers explored the relationship between CHC primary care visits and psychiatric ED visits to determine whether CHCs were reducing ED visits for individuals with mental illness. The researchers analyzed data for 143 counties across nine states between 2006 and 2011.

 

Results of the analysis showed that for a given county, an increase in CHC visits was associated with a decrease in psychiatric ED visits, measured by population and over time. In a county with a population of 100,000 people, for example, the data suggest a decrease of six psychiatric ED visits for every increase of 100 CHC visits.

 

The authors note that their research cannot speak to the quality or level of mental health care provided by CHCs as a component of primary care, or a direct association between an individual patient's care at a CHC and his or her future ED use. However, the findings indicate a potential role for the expansion of CHCs in diverting individuals from utilizing the ED for psychiatric care, and could have implications for public health policy.