Free clinics lighten ER overcrowding

PENN STATE (US) — People who receive primary care from free clinics are less likely to use the emergency department for minor issues, medical researchers report.

Nationally, the number of emergency departments has decreased but the number of emergency room visits have gone up. According to the National Association of Free and Charitable Clinics, there are more than 1,200 free clinics nationwide, many of which work in cooperation with a local hospital.

The researchers analyzed records of uninsured patients from five hospitals and four free clinics across neighboring Virginia communities.


Over three years, 52,010 individual uninsured patients visited at least one of the hospitals’ five emergency departments a total of 99,576 times. Approximately 10 percent of those emergency department visits were by patients who had been treated at free clinics associated with the hospitals in the first two years studied.

The researchers compared the diagnoses at the time of admittance to the emergency department between the free clinic patients and the non-free clinic patients. The five most common diagnoses were identical for both groups—sprains and strains, disorders of teeth and jaw, superficial injury or contusion, abdominal pain, and back problems.

The secondary diagnoses were not as similar for the two groups, but the mental health and substance abuse was the most common underlying condition for both groups of uninsured patients.

“Emergency department visits by free clinic patients were less likely to require the lowest levels of care, suggesting uninsured free clinic users were less likely to use the emergency department as their primary care provider,” the researchers write in a study published in the Journal of Health Care for the Poor and Uninsured.

Half of the ED visits in the study were avoidable, using the measurements the hospitals themselves use. By providing primary care for the uninsured, free clinics are able to help reduce non-emergency visits to the ED.

“The emergency department is an extremely expensive and inefficient way to handle many problems that show up there,” says Wenke Hwang, associate professor of public health sciences at Penn State College of Medicine.

“If hospitals support local free clinics, the ED will be less crowded and therefore have less need for expensive expansions. Free clinics are the cheaper solution.”

Researchers from  Wake Forest University School of Medicine and Davidson College contributed to the study, which was supported in part by the Hospital Corporation of America.

Source: Penn State