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Pediatric Primary Care Relationships and Non-Urgent Emergency Department Use in Children
Shannon Kirby1, William Wooten2, Adam J Spanier3
1Medical Student, University of Maryland, School of Medicine (S Kirby), Baltimore, Md.
Insights
Stronger patient-primary care provider relationships did not reduce non-urgent emergency department visits. Many caregivers lacked awareness of practice resources, opting for the ED for acute, non-urgent care needs.
Area of Science:
- Healthcare Management
- Public Health
- Pediatrics
Background:
- Non-urgent emergency department (ED) use increases healthcare costs and disrupts care continuity.
- Understanding factors influencing patient/guardian decision-making for non-urgent ED visits is crucial.
Purpose of the Study:
- To determine the association between the patient/guardian-primary care provider (PCP) relationship and non-urgent ED usage.
- To explore other factors related to non-urgent ED utilization in pediatric care.
Main Methods:
- A survey assessed PCP relationship strength (PDRQ-9), caregiver knowledge, and care-seeking behavior in 218 parent-child pairs.
- A 12-month retrospective chart review documented non-urgent ED visits.
- Regression analysis evaluated the association between PDRQ9 scores and non-urgent ED use.
Main Results:
- The patient-doctor relationship score (PDRQ-9) was not associated with non-urgent ED use (P = .46).
- Younger child age and shorter duration with the PCP practice were linked to increased non-urgent ED visits.
- Limited knowledge of PCP resources was observed; for most scenarios, over 50% of participants preferred the ED over their PCP.
Conclusions:
- No association was found between patient-doctor relationship strength and non-urgent ED use.
- Patient/guardian unawareness of practice resources and preference for the ED in acute, non-urgent situations were significant findings.
- Further research is needed to develop interventions aimed at reducing non-urgent ED utilization.
Objective:
Non-urgent emergency department (ED) use contributes to healthcare costs and disrupts continuity of care. Factors influencing patient/guardian decision-making in non-urgent situations are poorly understood. We sought to determine the association of patient/guardian - primary care provider (PCP) relationship with non-urgent ED usage and explore related factors.
Methods:
In an urban practice, we recruited 218 parent-child pairs and administered a survey with the PCP relationship (PDRQ-9), caregiver knowledge of office resources, and care-seeking behavior. We performed a 12-month retrospective chart review to document non-urgent ED visits. We evaluated the association of PDRQ9 and non-urgent ED usage by regression analysis.
Results:
Mean child age was 7.0 ± 5 years, and 32.6% of children had at least one non-urgent ED visit. Mean PDRQ9 score was 39.8 ± 7.3 and was not associated with non-urgent ED use (P = .46). Lower child age (P < .001) and shorter time coming to the PCP practice (P < .001) were both associated with increased non-urgent ED use. Only 36.4% reported usually going to their PCP when they are sick. Knowledge of office resources was limited, and when prompted with acute, non-urgent medical scenarios, in 4 of 5 scenarios, 50% or more of participants chose to go to the ED over communicating with or going to their PCP.
Conclusions:
We did not find an association between patient-doctor relationship strength and non-urgent ED usage. Many patients/guardians were unaware of the practice's resources and selected the ED as first choice for acute, non-urgent medical scenarios. Additional work is needed to determine interventions to reduce non-urgent ED use.
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