Photo Credit: Caiaimage/Robert Daly

 Access, convenience, affordability, and mental health issues are factors influencing why young adults choose urgent care or emergency services over primary care.

In recent years, the number of young adults with an established Primary Care Provider (PCP) has been declining. A study from the Kaiser Family Foundation found that 45% of adults ages 18 to 29 did not have a PCP, compared to 28% of adults ages 30 to 49, and 18% of adults ages 50 to 64.

There are many factors contributing to this decline. National PCP shortages, especially in rural areas, make access to primary care nearly impossible for many young people. Even for youth who have access to services, many additional barriers inhibit them from making it into the exam room. Results from a national text messaging poll of youth, published in the Journal of Adolescent Health, asked over 1,100 participants aged 14 to 24 for their perspectives on primary care. Researchers found that while young people recognized the importance of primary care, barriers such as difficulties in scheduling a timely appointment with their PCP, unaffordability of care, and overall lack of convenience limited their utilization of primary care services. Young people also reported difficulties finding a new PCP after aging out of pediatric care or moving away from home, which posed additional barriers to receiving care.

Increased Use of Urgent Care by Young Adults

According to the Journal of Urgent Care Medicine, “Gen Z and Millennial consumers (born between 1981-2012) use urgent care more widely, with around 36% reporting having been to an urgent care clinic in the past 6 months, compared with 19% of Baby Boomers (born between 1946-1964).” Additionally, only 47% of Gen Z patients prefer a PCP to urgent care, whereas 90% of Baby Boomers prefer to receive care from a PCP.

Access, convenience, and affordability are not the only reasons that young adults are choosing urgent care or emergency services over primary care. Mental health symptoms, which are on the rise among youth, can also create an additional barrier to accessing primary care as well as the perceived urgency needed to treat symptoms. The 2021 CDC Youth Risk Behavior Survey (YRBS) results revealed that 42% of high school students struggle with persistent feelings of sadness or hopelessness and 29% experienced poor mental health. According to research published in Health Expectations, young people are often anxious about the seriousness of their symptoms, sometimes exacerbated by searching for medical answers online or seeking advice from their friends or family who may encourage them to seek care urgently. Study participants with underlying mental health issues or ongoing life stressors reported a reduced capacity to cope with physical symptoms and the impact on their daily lives, “increasing the perceived need for urgent help and reassurance.”

The Role of PCPs & Clinical Staff

Primary care offices can take steps to engage and retain young adult patients. Recommendations from the American Academy of Family Medicine and researchers at the University of Michigan include:

• Know the laws. Educate professionals and staff about state-specific minor consent and confidentiality laws and clearly display them in clinic spaces
• Be an Askable Adult. Create an environment where young people can ask questions free of judgment from the moment, they schedule an appointment to the time they check out
• Create appointment flexibility. Offer same-day appointment slots, as well as extended evening and weekend hours
• Provide multiple ways to communicate. Consider offering a various accessible appointment options including physician visits, non-physician professional visits, telemedicine, and portal messaging
• Offer many scheduling options. Provide online scheduling options and text messaging for appointment reminders and test results
• Share what it will cost. Be upfront about fees and medical expenses and offer payment plans
• Show who you are. Use social media to showcase the personality, culture, and bedside manners of your team while also demonstrating your medical expertise
• Make office space feel like it is for youth. Display youth-friendly healthcare materials designed in collaboration with young adults
• Help youth prepare for engaging in care as adults. Support youth transitioning from pediatric to adult primary care providers by communicating with young people about the steps needed to transition to new PCPs in early adulthood

Attitudes about health and healthcare are established from an early age and continue to develop through adolescence and beyond. A more patient-centered approach to meeting the needs of young people can help them develop lifelong healthy habits and relationships with primary care providers.

About ETR

ETR | Education, Training, and Research is a non-profit organization that envisions a world where all individuals and communities achieve their best health. Through our work, we improve the health and well-being of youth and communities by championing science. To learn more, visit www.etr.org