Pediatric non-urgent emergency department visits and prior care-seeking at primary care

Abstract

Background We aimed to examine how caregiver perceptions of primary care affects care-seeking prior to pediatric non-urgent ED visits. Methods We performed a cross-sectional survey of caregivers of children presenting to a pediatric ED during weekday business hours and triaged as low acuity. We first compared caregiver sociodemographic characteristics, perceptions of primary care, and stated preference in care sites (ED vs PCP) for caregivers who had sought care from their child’s PCP office versus had not sought care from their child’s PCP office prior to their ED visit. We then examined odds of having sought care from their PCP office prior to their ED visit using multivariable logistic regression models sequentially including caregiver primary care perceptions and stated care site preferences along with caregiver sociodemographic characteristics. Results Of 140 respondents, 64 (46%) sought care from their child’s PCP office prior to presenting to the ED. In unadjusted analysis, children insured by Medicaid or CHIP, caregivers identifying as Black, and caregivers with lower educational attainment were less likely to have sought PCP care before presenting to the ED (p < 0.005, each). Caregivers who had sought PCP care were more likely to prefer their PCP relative to the ED in terms of ease of travel, cost, and wait times (p < 0.001, all). When including these stated preferences in a multivariable model, child insurance, caregiver race, and caregiver education were no longer significantly associated with odds of having sought PCP care prior to their ED visit. Conclusions Differential access to primary care may underlie observed demographic differences in non-urgent pediatric ED utilization.

Factors Affecting Nonurgent Pediatric Emergency Department Visits and Parental Emergency Overestimation

“…In another study, it was found that lower educational attainment levels were associated with not seeking primary care physician care before presenting to the ED. 15 Akbayram and Coskun 13 also found that fathers with lower education levels preferred other specialists over family physicians. On the other hand, Burokiene et al 20 showed that more educated parents and parents with a higher income were more likely to bring their child to ED without visiting a primary care physician.…”

“…In that study, onset of child's complaints outside working hours was the most common reason among high school or university graduate mothers. In another study, it was found that lower educational attainment levels were associated with not seeking primary care physician care before presenting to the ED 15 . Akbayram and Coskun 13 also found that fathers with lower education levels preferred other specialists over family physicians.…”

“…Parents perceiving their child's health status as urgent or thinking they will worsen, considering they might get more favorable and faster service at emergency settings at more convenient times, and need for reassurance are some of the reasons that lead parents into PED settings for nonurgent conditions 2,10–12 . Similarly, lack of access to primary care services, especially after office hours, or dissatisfaction with other health care services, not having a continuity physician, and the complexity of living in low-income areas are other reasons for nonurgent emergency department (ED) use 13–16 . Among sociodemographic characteristics, lack of any insurance or private insurance, lower socioeconomic status, lower parental education attainment, and low health literacy were demonstrated to be associated with nonurgent visits 10,15,17,18 .…”

“…[13][14][15][16] Among sociodemographic characteristics, lack of any insurance or private insurance, lower socioeconomic status, lower parental education attainment, and low health literacy were demonstrated to be associated with nonurgent visits. 10,15,17,18 In a systematic review of mainly adult nonurgent ED use, a conceptual model was created, where the effect of sociodemographic factors was posited as likely associated with other potential causal factors such as access, perceived severity, and convenience. 16 Factors that lead to nonurgent visits to PED are complex and multifactorial.…”

“…2,[10][11][12] Similarly, lack of access to primary care services, especially after office hours, or dissatisfaction with other health care services, not having a continuity physician, and the complexity of living in low-income areas are other reasons for nonurgent emergency department (ED) use. [13][14][15][16] Among sociodemographic characteristics, lack of any insurance or private insurance, lower socioeconomic status, lower parental education attainment, and low health literacy were demonstrated to be associated with nonurgent visits. 10,15,17,18 In a systematic review of mainly adult nonurgent ED use, a conceptual model was created, where the effect of sociodemographic factors was posited as likely associated with other potential causal factors such as access, perceived severity, and convenience.…”