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Primary paediatric care models and non-urgent emergency department utilization: an area-based cohort study
Sara Farchi1, Arianna Polo, Francesco Franco
1Public Health Agency, Lazio region, Via di Santa Costanza, 53 00198 Rome, Italy. farchi@asplazio.it
Insights
Children in group or network paediatrician practices had lower non-urgent Emergency Department (ED) use compared to those in individual practices. Improving primary paediatric care access is key.
Area of Science:
- Health Services Research
- Paediatric Healthcare Management
- Emergency Medicine Utilization
Background:
- Investigating the relationship between primary paediatric practice models and non-urgent Emergency Department (ED) visits.
- Understanding how different practice structures influence healthcare-seeking behaviors in children.
Purpose of the Study:
- To evaluate the association between individual, network-affiliated, and group paediatric practice models and non-urgent Emergency Department (ED) utilization among children aged 0-6 years.
- To identify practice characteristics that may reduce unnecessary ED visits.
Main Methods:
- Utilized 2006 Regional Paediatric Patient files, Community-based Paediatrician (CBP) file, and Emergency Information System data.
- Analyzed ED visits, excluding planned visits, trauma/poisoning, and critical triage cases.
- Applied multivariate logistic regression to assess the odds ratio of ED visits based on practice type (individual, network, group).
Main Results:
- A cohort of 293,662 children was analyzed, with 43,347 ED visits recorded.
- Group paediatrician patients showed lower ED use (OR 0.84; 95%CI 0.73-0.96) compared to individual practices.
- Network paediatrician patients also demonstrated reduced ED use (OR 0.92; 95%CI 0.85-1.00) versus individual practices.
Conclusions:
- A weak association exists between paediatric primary practice type and Emergency Department (ED) use.
- Findings suggest that optimizing primary paediatric care organization can improve patient access and potentially decrease non-urgent ED visits.
- Further improvements in primary care delivery are recommended to enhance efficiency and patient care.
Background:
The aim of this study was to evaluate the association between different primary paediatric practice models (individual, network -affiliated but in separate office-, and group practice) and non urgent utilization of the Emergency Department (ED).
Methods:
The data sources were: the 2006 Regional Paediatric Patient files (0-6 years old), the Regional Community-based paediatrician (CBP) file and the 2006 Emergency Information System. We recorded and studied the ED visits of children, excluding planned ED visits, visits for trauma/poisoning and those that were assigned non deferrable/critical triage codes. A multivariate logistic regression was applied to estimate the adjusted odds ratio of an ED visit. The exposure was the type of paediatric practice that served the child: individual, network or group practice. Various characteristics of the child were considered.
Results:
The cohort was composed of 293,662 children. In the 2006, 43,347 ED visits occurred (147.6 per 1000). Multivariate logistic models showed lower ED use for group paediatrician patients (OR 0.84; 95%CI 0.73-0.96) and for network paediatrician patients (OR 0.92; 95%CI 0.85-1.00) compared to patients served by an individual practice.
Conclusions:
This study shows that there is a weak association between the type of paediatrician primary practice and emergency department use. Our results highlight the necessity to continue to improve the organization of paediatrician primary practice, in order to increase patient access to primary paediatric care.
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