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Drivers for low-acuity pediatric emergency department visits in two tertiary hospitals in Switzerland: a
Manon Jaboyedoff1, Carl Starvaggi2, Joan-Carles Suris3
1Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. manon.jaboyedoff@chuv.ch.
Insights
Economic hardship drives frequent low-acuity visits to pediatric emergency departments (PEDs). Families facing financial difficulties are more likely to use PEDs for non-urgent care, highlighting a need for social support.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Socioeconomic Determinants of Health
Background:
- Low-acuity pediatric emergency department (PED) visits are common in high-income nations.
- These visits strain healthcare resources and impact patient care.
- Understanding the drivers of these visits is essential for improving healthcare delivery.
Purpose of the Study:
- To identify factors associated with low-acuity PED visits in Switzerland.
- Investigated socioeconomic status, demographics, and family medical resources.
- Aimed to inform strategies for reducing unnecessary PED utilization.
Main Methods:
- Prospective, questionnaire-based study in two Swiss tertiary care PEDs.
- Collected data on demographics, socioeconomic status, and medical resources from 778 visits.
- Defined low-acuity visits by triage category (4 or 5), no tests, and home discharge.
- Used logistic regression to analyze factors associated with low-acuity visits.
Main Results:
- 58% of PED visits were classified as low-acuity.
- Caregiver difficulties with bill payment significantly increased the odds of low-acuity visits (aOR 2.6).
- Previous PED use within 6 months was also associated with low-acuity visits (aOR 1.7).
- Parental education, country of birth, employment, and social network were not significant factors.
Conclusions:
- Economic precariousness is a key driver of low-acuity PED visits in Switzerland.
- Despite universal health coverage, financial strain influences healthcare-seeking behavior.
- Healthcare providers should screen for financial difficulties and connect families to social support services.
Purpose:
Low-acuity pediatric emergency department (PED) visits are frequent in high-income countries and have a negative impact on patient care at the individual and health system levels. Knowing what drives low-acuity PED visits is crucial to inform adaptations in health care delivery. We aimed to identify factors associated with low-acuity PED visits in Switzerland, including socioeconomic status, demographic features, and medical resources of families.
Methods:
We conducted a prospective, questionnaire-based study in the PEDs of two Swiss tertiary care hospitals, Bern and Lausanne. We invited all consecutive children and their caregiver attending the PED during data collection times representative of the overall PED consultation structure (e.g. day/night, weekdays/weekends) to complete a questionnaire on demographic features, socioeconomic status, and medical resources. We collected medical and administrative data about the visit and defined low-acuity visits as those meeting all of the following criteria: (1) triage category 4 or 5 on the Australasian Triage Scale, (2) no imaging or laboratory test performed, and (3) discharge home. We used a binary multiple logistic regression model to identify factors associated with low-acuity visits.
Results:
We analysed 778 PED visits (September 2019 to July 2020). Most children visiting our PEDs had a designated primary care provider (92%), with only 6% not having seen them during the last year. Fifty-five per cent of caregivers had asked for medical advice before coming to the PED. The proportion of low-acuity visits was 58%. Low-acuity visits were associated with caregiver's difficulties paying bills (aOR 2.6, 95% CI 1.6 - 4.4), having already visited a PED in the last 6 months (aOR 1.7, 95% CI 1.1 - 2.5) but not with parental education status, nor parental country of birth, parental employment status or absence of family network.
Conclusion:
Economic precariousness is an important driver for low-acuity PED visits in Switzerland, a high-income country with compulsory health coverage where most children have a designated primary care provider and a regular pediatric follow-up. Primary care providers and PEDs should screen families for economic precariousness and offer anticipatory guidance and connect those in financial need to social support.
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