Medical and Social Factors Affecting Emergency Department–Based Linkage to Primary Care for Recently Arrived Immigrants: A Single-Center Retrospective Study

Recent immigrants often experience significant barriers to engaging in healthcare in the US. Without established primary care (PC), immigrants may use the Emergency Department (ED) to address complex medical and social needs even though they are at risk for sub-optimal chronic disease management by doing so. We examine differences between recent immigrants who are successfully referred from the ED to specialized primary care for immigrant and refugee patients compared to those who do not establish care.

This retrospective cohort study at an urban, safety-net hospital used all ED encounters from 1/1/2022-2/6/2024 for recently arrived immigrants >= 18 years of age. Demographic, ED clinical encounter, social determinants of health screening, readmission, and PC data were collected. We describe visit outcomes for patients referred to PC and the medical and social factors associated with successful linkage. Chi-square tests were used to assess potential associations.

4,716 patients were identified. The mean age was 38.5 (SD: 14.3), 51% were men, and 56% spoke Spanish. Within this sample, 161 patients (3.4%) were referred to PC from the ED, and 72% (n=116) completed at least one visit within an average of 151 days (SD: 108.3). Patients who attended PC visits were more likely to endorse housing insecurity (47.4%, p=0.004), food insecurity (28.5%, p=0.0005), and transportation difficulties (19%, p=0.0014). In a multivariable regression model, only patients with missing housing status had significantly lower odds (aOR = 0.149; p= 0.015) of completing PC visits, controlling for age, language, index ED visit ESI level, hypertension, and screening for housing, food, or transportation insecurity. Patients who endorsed housing insecurity had higher odds (aOR= 2.1) of completing PC visits, though not statistically significant (p= 0.101).

Among recently arrived immigrant patients referred for specialized primary care from the ED, there was a high level of successful linkage, suggesting an interest in comprehensive care when available. Previous studies have demonstrated variable primary care and ED utilization among this population. The patients who completed PC visits screened positive for housing, food, and transportation difficulties, reinforcing the barriers that ED clinicians must consider in their medical management and as they help this population to connect to care.