Nonurgent pediatric emergency department visits: Care-seeking behavior and parental knowledge of insurance

Abstract

OBJECTIVES The goals of this study were to describe the factors associated with utilization of emergency services for nonurgent illnesses by insured children in a pediatric emergency department (PED) and to assess parental knowledge of their insurance and its influence on care-seeking behaviors. METHODS We conducted a prospective, descriptive survey of parents of insured children evaluated for nonurgent illnesses in an urban PED. RESULTS A total of 251 surveys were completed. The primary reason chosen by the parent for the PED visit was convenience in 62.8% of cases, a perceived true emergency in 33.6%, and lack of other access to a physician in 3.6%. Parents choosing the PED for perceived emergencies were more likely to state that the illness was life threatening or required hospital admission than those who came because of convenience (33/84 vs. 28/157; < 0.001). Only 38.7% stated that they were educated as to what problems are considered emergencies by their insurance carriers. PED referrals for nonurgent complaints are required by the insurance carrier for 74.9% of the population; however, only 37.2% of the parents stated that referrals were necessary. Primary care physician (PCP) contact was made prior to the visit by 45.4% of parents. Of those who called the PCP, 72.6% stated that they were referred to the PED. Of the parents who believed that a referral was required, those stating that the problem was an emergency were more likely to have contacted the PCP than those who came because of convenience (27/37 vs. 22/46; < P 0.037).CONCLUSIONS Parents frequently do not understand their insurance coverage as it relates to emergency care utilization. This lack of knowledge influences their care-seeking behaviors for nonurgent illnesses. Convenience is a significant factor in PED utilization for nonurgent complaints.

Emergency department visits: Why adults choose the emergency room over a primary care physician visit during regular office hours?

“…[10] In addition to these points, multiple studies have shown that many patients view the ED as faster and more convenient. [4,5,7,11] In Kentucky, one survey revealed that patients in fact would prefer to see their usual primary care physicians, but nearly half would "seek care elsewhere" if they could not be seen the same day. [12] Our study did not show a statistically significant difference in patient perceptions regarding convenience of ED versus primary care providers.…”

“…that though many patients admittedly do not attempt to make contact with their primary care physicians, of those that do, a vast majority are directed to go to the ED. [2,4,13] An United Kingdom study found that patients whom self-referred themselves to the ED had the same incidence of non-emergent complaints as those patients referred by their primary care providers. [14] In our research, the self-referral versus primary care referral rates showed more patients not contacting their primary care physicians before visiting the ED.…”

“…All of these theories have been found to be ineffective solutions during later studies and investigations of the matter. [2,4,7,13] A reasonable and effective solution to the issue has yet to be discovered or identified. The fact of the matter remains clear that patients who perceive their complaints as serious enough to warrant medical evaluation the same day, regardless of the true urgency of their conditions, will continue to utilize the ED.…”

“…Factors that have been speculated to be associated with non-emergent use have been noted to include low socioeconomic status, lack of access to primary care, lack of insurance, convenience of "on demand care" and the patient's individual perception of their complaint urgency. [4] As one might expect, some studies have shown that less urgent complaints are seen more often in late evening hours and on weekends when clinics and private offi ces are not open. [2] It is for this reason that the study we conducted at our hospital was designed to exclude patients visiting the ED during those time frames in order to take out that motivating variable.…”

“…[7] In one Virginia urban hospital study of insured patients only, nearly all patients had access to a primary care provider and it was found that the most significant factor in non-emergent ED use was convenience. [4] Convenience was also a key influence, along with limited access to "timely" primary care in another study undertaken during business hours in a suburban pediatric ED. [2] An urban pediatric ED study, completed during regular office hours, where participants and/or parents responded that they had an established primary care physician, discovered that prolonged waiting times to see a primary care provider was a major factor in the decision to choose the ED for non-emergent problems.…”