Nonemergency Acute Care: When It’s Not the Medical Home

Abstract

The American Academy of Pediatrics (AAP) affirms that the optimal location for children to receive care for acute, nonemergency health concerns is the medical home. The medical home is characterized by the AAP as a care model that “must be accessible, family centered, continuous, comprehensive, coordinated, compassionate, and culturally effective.” However, some children and families use acute care services outside the medical home because there is a perceived or real benefit related to accessibility, convenience, or cost of care. Examples of such acute care entities include urgent care facilities, retail-based clinics, and commercial telemedicine services. Children deserve high-quality, appropriate, and safe acute care services wherever they access the health care system, with timely and complete communication with the medical home, to ensure coordinated and continuous care. Treatment of children under established, new, and evolving practice arrangements in acute care entities should adhere to the core principles of continuity of care and communication, best practices within a defined scope of services, pediatric-trained staff, safe transitions of care, and continuous improvement. In support of the medical home, the AAP urges stakeholders, including payers, to avoid any incentives (eg, reduced copays) that encourage visits to external entities for acute issues as a preference over the medical home.

Effect of Population Lockdown on Pediatric Emergency Room Demands in the Era of COVID-19

“…We are aware of some limitations of our study. The size and characteristics of our work may be not representative of the whole target population especially in places where medical homes as optimal locations for children to receive care for acute, non-emergency, health concerns are available (25). Furthermore, we have no direct proofs of the underlying personal/social motivations which prompted parents to ED consultations.…”

Comparison of a Novel Handheld Telehealth Device with Stand-Alone Examination Tools in a Clinic Setting

“…Both the American Academy of Pediatrics and the Academy of Family Medicine have recommended guidelines for scheduled pediatric clinic visits. 1,2 These visits are typically performed in an office or in a clinic setting, incorporating a history and physical examination, developmental assessment, aspects of preventative medicine, and immunizations. Assessment of the ill child may occur in the office, urgent care, or emergency department settings.…”

Pediatrician, watch out for corona-phobia

“…If possible, distancetechnologies should be employed when feasible. & The use of telemedicine in children less than 2 years of age should be undertaken with caution in accordance with previous AAP recommendations [17]. & Even in this time of isolation and quarantine, parental concern for the child's well-being or an explicit request to be physically evaluated should be seriously taken to consideration.…”

“…This clearly is not possible or difficult in the setting of telemedicine, mostly when done over the phone without video input as described in our cases. With that in mind, the American Academy of Pediatrics (AAP) has recommended that telehealth services as well as acute care centers, which are not linked to the child's medical file, should not treat infants younger than 2 years of age [17].…”