Lack of a regular source of care among children using a public hospital emergency department

Objectives: This study examined risk factors for not having a regular source of care among children presenting to an urban public hospital for nonappointment care. Lack of a regular source of care is associated with decreased use of appropriate health care services and preventive care among children. Methods: A cross-sectional survey was conducted for all children less than 16 years of age attending an emergency department at an urban public hospital over a consecutive 7-day period. Univariate and multivariate logistic regression analyses were conducted. Results: In 791 interviews available for analysis, 52% of preschool children and 66% of school-aged children did not have a regular source of care. Children without a regular source of care were more likely to present for nonurgent conditions (P < 0.0005). In multivariate analysis, older age of the child (OR = 1.6, 95% CI 1.13-2.25), lack of insurance (OR = 1.47, 95% CI 1.03-2.11), and lack of personal vehicle (OR = 1.44, 95% CI 1.05-1.97) were associated with not having a regular source of care. Conclusions: The majority of children using an urban emergency department were without a regular source of care. In this population, no single factor identified children without a regular source of care, but increased age and lack of insurance were associated with it. Addressing this situation will require a multifaceted approach that includes, but is not limited to, decreasing financial barriers.