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A health promotion intervention for families in a Medicaid managed care plan
1Department of Pediatrics, University of Pittsburgh, Children's Hospital of Pittsburgh, PA, USA. v-chande@nwu.edu
Insights
A health promotion intervention did not change healthcare seeking behaviors. Patients receiving the intervention showed no difference in primary care provider visits or pediatric emergency department use for minor illnesses compared to the control group.
Area of Science:
- Pediatric Health
- Health Services Research
- Health Promotion
Background:
- Pediatric emergency departments (PEDs) often manage minor illnesses.
- Effective health promotion strategies are needed to guide parents towards appropriate primary care.
- Understanding healthcare utilization patterns is crucial for resource allocation.
Purpose of the Study:
- To evaluate if a health promotion intervention influences patient care-seeking behaviors.
- To determine if the intervention increases primary care provider (PCP) visits.
- To assess if the intervention reduces pediatric emergency department (PED) visits for minor illnesses.
Main Methods:
- A prospective, randomized, controlled study was conducted in a pediatric emergency department.
- Infants under 13 months presenting with minor illnesses were randomized into intervention or control groups.
- The intervention group received health promotion education and a follow-up appointment; the control group received usual care. Healthcare utilization was tracked for one year.
Main Results:
- No statistically significant differences were observed in healthcare utilization between the intervention and control groups at 12-month follow-up.
- Rates of visits to the pediatric emergency department (PED) for minor illnesses were similar (82% vs. 78%).
- Rates of visits to the primary care provider (PCP) for well-child care were also similar (79% vs. 83%).
Conclusions:
- The health promotion intervention did not alter healthcare utilization habits.
- The study found no significant impact on redirecting patients from the PED to PCPs for minor illnesses.
- Further research may be needed to identify effective strategies for modifying healthcare-seeking behaviors in pediatric populations.
Objective:
To determine whether implementation of an intervention based on a model of health promotion will encourage patients to seek care from their primary care provider (PCP) and reduce visits to the pediatric ED (PED) for minor illness.
Methods:
Prospective, randomized, controlled study in the PED of an urban children's hospital (CH). Children <13 months old, enrolled in a Medicaid managed care plan, who identified the CH as their site for primary care and presented to the PED for evaluation of minor illness were enrolled after being seen by the triage nurse, before being seen by a physician. Subjects were randomly assigned to the intervention (I) group or control (C) group. Parents of all enrollees completed a survey about health care utilization habits. Each family in the I group received health promotion teaching from a single investigator. The intervention consisted of a review of the child's medical record with the parents, an explanation of what to expect at future well-child visits, and a discussion of the role of the PCP. A follow-up appointment was also provided prior to discharge from the PED. The C group received usual care. Use of health care by all subjects was tracked for one year by medical record review and phone interviews at six and 12 months.
Results:
102 subjects in the I group and 93 in the C group (mean +/- SD ages 6.4 months +/- 3.8 and 7.2 months +/- 3.9, respectively, p = 0.15) were enrolled from March 1996 to November 1996. The two groups were similar with respect to demographics and overall health status at enrollment. At study entry: 94 of 102 (92%) subjects in I and 87 of 93 (94%) in C had made at least one visit to the PED in the previous 12 months (p = 0.11); 95 of 102 (93%) in I and 75 of 93 (81%) in C had seen their PCP at least once for well-child care (p = 0.24). Twelve-month follow-up by medical record review was completed for all subjects; phone interviews were completed in 90 of 102 (88%) in I and 80 of 93 (86%) in C. At 12-month follow-up: 84 of 102 (82%) in I and 73 of 93 (78%) in C had made at least one visit to the PED (p = 0.59); 81 of 102 (79%) in I and 77 of 93 (83%) in C had made at least one visit to their CH PCP (p = 0.54).
Conclusions:
There was no difference in health care utilization between the intervention and control groups at 12-month follow-up. The health promotion intervention did not alter utilization habits.