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The effect of prior interactions with a primary care provider on nonurgent pediatric emergency department use
David C Brousseau1, Jo Bergholte, Marc H Gorelick
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, 53226, USA. dbrousse@mail.mcw.edu
Insights
Difficulty obtaining timely primary care increases nonurgent pediatric emergency department visits. Improving access to primary care providers (PCPs) can reduce unnecessary emergency department use.
Area of Science:
- Pediatric healthcare access
- Emergency department utilization
- Primary care provider (PCP) interactions
Background:
- Nonurgent pediatric emergency department (ED) visits represent a significant burden on healthcare resources.
- Understanding factors contributing to these visits is crucial for developing targeted interventions.
- Timely access to primary care is hypothesized to influence healthcare seeking behaviors.
Purpose of the Study:
- To investigate the association between parental-reported difficulty accessing primary care without long waits and nonurgent pediatric ED use.
- To identify if challenges in obtaining timely PCP appointments are a predictor of nonurgent ED visits.
Main Methods:
- A case-control study was conducted involving children aged 6 months to 12 years presenting to an urban pediatric ED.
- Cases had nonurgent chief complaints, while controls had emergent complaints.
- Caregivers completed Consumer Assessment of Health Plans (CAHPS) surveys to assess PCP interactions, including wait times for appointments. Multivariate logistic regression analyzed the association between wait times and nonurgent ED use.
Main Results:
- Caregivers of children with nonurgent complaints reported significantly greater difficulty accessing care without long waits compared to those with emergent complaints (P<.001).
- Multivariate analysis revealed that increased ability to get timely care from a PCP was associated with a reduced likelihood of nonurgent ED visits (OR, 0.48; 95% CI, 0.32-0.72).
- Demographic differences were observed between case and control groups, with emergent complaints associated with older children, higher socioeconomic status, and established PCP relationships.
Conclusions:
- Parental-reported difficulty in obtaining timely care from a primary care provider is a significant risk factor for nonurgent pediatric emergency department use.
- Improving access to primary care, specifically reducing wait times for appointments, may serve as an effective strategy to decrease nonurgent ED visits.
- These findings underscore the importance of accessible and responsive primary care in managing pediatric healthcare needs and optimizing ED resource allocation.
Objective:
To determine the effect of parental reported difficulty getting care without long waits from a primary care provider (PCP) on nonurgent pediatric emergency department (ED) use.
Design:
Case-control study.
Setting:
Pediatric ED within an urban pediatric hospital.
Participants:
Children, aged 6 months to 12 years, who presented with a chief complaint from a predetermined list of nonurgent (cases) or emergent complaints (controls).
Main Outcome Measures:
Caregivers assessed interactions with a PCP during the previous 12 months by completion of a Consumer Assessment of Health Plans (CAHPS) survey. Baseline demographic variables were compared. Composite CAHPS scores assessing difficulty meeting medical needs, including getting care without long waits, were compared using median tests. Multivariate logistic regression was used to assess the effect of getting care without long waits on nonurgent ED use.
Results:
Of 821 caregivers approached, 719 (87.6%) completed the survey, including 366 cases (50.9%) and 353 controls (49.1%). Those with emergent complaints were older, healthier, and more likely to be male; had higher caregiver education and income levels; and were more likely to have a PCP. Analysis of the CAHPS composite scores revealed increased difficulty meeting medical needs for those with nonurgent complaints, with the greatest difference noted for getting care without long waits (median score, 3.25 vs 3.67; P<.001). In multivariate regression, increased ability to get care without long waits was associated with decreased odds of nonurgent ED use (odds ratio, 0.48; 95% confidence interval, 0.32-0.72).
Conclusion:
Parental-reported previous difficulty getting care without long waits from a PCP is a risk factor for nonurgent ED use.
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