Hundreds of Baltimore City residents visit the emergency department each year for asthma, dehydration and skin infections — illnesses that are often preventable through access to primary care, a new report shows.
“They are getting so sick because they don’t have their own doctor to keep them healthy,” said Baltimore City Health Commissioner Joshua Sharfstein.
For the report, called Ambulatory Care Sensitive Hospitalizations and Emergency Department Visits, RAND Corp. researchers examined emergency department visits and hospitalizations for preventable conditions – common indicators for the efficacy of primary care.
Those rates were “substantially higher than those in other Maryland counties, in Maryland as a whole,” the report states.
“What jumps out is how high the rates are and what an important opportunity and responsibility they have to help it get better,” said co-author Nicole Lurie.
The report, which Sharfstein called the “first real systematic” assessment of the problem, also detailed the need by neighborhood, showing the highest rates were in East and West Baltimore.
“It really demonstrates the overall barrier of the health care system,” he said.
For example, the rate of unnecessary hospitalizations rose 23 percent from 2000 to 2007 among 40- to 64-year-olds to 55 hospitalizations per 1,000 people per year, according to the report. Among youth, that rate rose 10 percent to 15 per 1,000.
In 2007, 830 children were hospitalized for asthma and 1,929 seniors admitted for dehydration.
Baltimore City would need an additional 130,000 to 159,000 primary care visits to avoid these emergency visits and hospitalizations, the report found. This translates to about 25 more primary care doctors or nurse practitioners, Sharfstein said.
The state could be spending millions of dollars each year on hospital care that could be directed on outpatient services, said Sharfstein, adding he will be working with state leaders to find solutions and financing.
“It’s an issue not unique to Baltimore,” said John Colmers, secretary of the Maryland Department of Health and Mental Hygiene.
The lack of primary care may be due in part to low pay for primary care doctors, Colmers said, and a state panel is considering ways to offer incentives such as loan forgiveness programs.
“We are interested in looking at what we can do in early next year to spur a dialogue on ways to bolster primary care.”
