Transition into Adult Health Care is a Rocky Road for 20-Somethings

Adults in their 20s Use EDs More, Outpatient Care Less

March 24, 2010

In many cases, young adults went to the ED when they could have been treated in an outpatient clinic.

Young adults, a generally healthy population, are increasingly flocking to emergency departments (EDs) instead of outpatient clinics for medical treatment. Young adults remain the most likely age group to lack health insurance and often lose their insurance during this pivotal transition period between adolescence and adulthood.

Young adults receive a significant proportion of their care in the ED – nearly twice as much as children and adolescents and nearly three times as much as adults older than 30, according to a recent study. Young adults without insurance or with public insurance were more likely to be treated in the ED than young adults with private insurance.

“Young adults need help navigating the health care system. There are very few resources to help them make the transition from adolescence to adulthood,” said Robert J. Fortuna, M.D., M.P.H., principal investigator of the study and a senior instructor of Pediatrics and Internal Medicine at the University of Rochester Medical Center.

The study’s authors focused on the usage of health care among young adults in part because they are the leading age group for many types of risky behavior, as rates of substance abuse, sexually transmitted illnesses, homicide and motor vehicle accidents all peak. As adolescents move into young adulthood, their suicide rate triples and they have considerably higher rates of tobacco use, binge drinking and illicit drug use.

Between 1996 and 2006, young adults’ ED visits increased by 5,520,000 visits. By 2006, nearly a quarter (22 percent) of all health care delivered to young adults occurred in the ED. Young adults were more likely to be cared for in the ED for both injury-related and non-injury-related problems.

A disproportionate amount of health care delivered to black young adults in the ED, considerably more than white. Nearly half of all health care provided to young black men (48.5 percent) was delivered in the ED, which shot up 35.4 percent in 1996.

Authors suggested the increase may be related to such factors as barriers in accessing primary care, disparities in preventive care services or inequalities in preventive counseling and health education.

While some cases might have needed immediate attention by providers, the majority of the cases were not of an urgent nature. Less than 5 percent of young adults were admitted to the hospital following treatment.

In most cases, young adults were triaged to less urgent times and required lower rates of admission, which suggests that at least a portion of the health care provided could have been done in the outpatient setting, said Fortuna.

“Access to a usual source of primary care is associated with improved overall health outcomes and lower rates of preventable ED use,” said Fortuna. “Improving health access for young adults will require a multifaceted approach to expand health care coverage, improve transition between adolescent and adult care, and increase overall awareness of the importance for young adults to establish a usual source of care.”

The study, which was conducted by researchers at the University of Rochester Medical Center, examined data collected from 17,048 young adult ED visits and 14,443 young adult outpatient visits in the National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey.

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