If doctors don't provide after-hours care, patients end in hospital ER WASHINGTON, Dec. 14 (UPI) -- One-in-five U.S. patients who attempted after-hours contact with their primary care physician reported it was very or somewhat difficult, researchers say. Ann S. O'Malley, a senior fellow at the Center for Studying Health System Change in Washington, said one goal of the Affordable Care Act is to improve patients' access to primary care and the coordination of that care. An important ingredient in achieving that goal is ensuring patients have access to their primary care practice outside of regular business hours, but many do not and are left to seek care at a hospital emergency room -- where the cost of care is much higher. O'Malley analyzed the 2010 Health Tracking Household Survey and found of those with a usual source of primary care, 40 percent reported that their practice offered extended hours, such as at night or on weekends. Those who reported less difficulty contacting a clinician after hours had significantly fewer emergency department visits -- 30.4 percent compared with 37.7 percent. The findings, published in the journal Health Affairs, provide a valuable baseline on after-hours access, especially as patient-centered medical homes and accountable care organizations expand. "Increasing support to primary care practices to offer or coordinate after-hours care may help reduce rates of emergency department use and unmet medical need," the study said.