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Advice seeking and appropriate use of a pediatric emergency department
T F Oberlander1, I B Pless, G E Dougherty
1Department of Developmental and Behavioral Pediatrics, Children's Hospital, Boston, MA.
Insights
Seeking advice from a physician and family before an unscheduled pediatric emergency department (PED) visit improves appropriate use for minor illnesses. Having a regular doctor also contributes to better decisions for pediatric care.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Utilization
- Health Services Research
Background:
- Unscheduled visits to pediatric emergency departments (PEDs) for minor illnesses raise concerns about resource allocation.
- Understanding factors influencing appropriate PED use is crucial for optimizing pediatric healthcare delivery.
Purpose of the Study:
- To investigate whether seeking advice before an unscheduled pediatric emergency department visit impacts the appropriateness of its use for minor illnesses.
Main Methods:
- A cross-sectional questionnaire survey was conducted with parents visiting a major urban children's hospital's PED.
- Data were collected from 489 parents over two periods in 1989.
- Appropriateness of the visit was assessed by two pediatricians based on structured criteria.
Main Results:
- Thirty-four percent of the surveyed visits were deemed appropriate.
- Seeking advice from both a physician and a non-physician prior to the visit was associated with significantly higher appropriateness (47%) compared to no advice (29%).
- Having a regular physician and being one of two children in the family were also linked to more appropriate PED use.
Conclusions:
- Prior advice seeking, particularly from both medical and non-medical sources, positively influences appropriate pediatric emergency department utilization.
- Establishing a relationship with a regular physician and prior childcare experience are also key factors in appropriate decision-making for pediatric care.
Objectives:
To determine whether seeking advice prior to an unscheduled visit to a pediatric emergency department (PED) influences appropriate use of this setting for minor illnesses.
Design:
Cross-sectional questionnaire survey.
Setting:
The medical emergency department of the Montreal (Quebec) Children's Hospital, a major referral and urban teaching hospital.
Participants:
Four hundred eighty-nine of 562 consecutive parents visiting the PED over two periods, one in February and the other in July 1989.
Interventions:
None.
Measurements/Main Results:
Parents of children between 0 and 18 years of age visiting the PED were asked whether they had previously sought advice from family, friends, or a physician. Other factors possibly related to the decision to seek care were also measured. Appropriateness was rated, blind to discharge diagnosis, by two pediatricians using a structured series of questions incorporating the child's age, time of the visit, clinical state, and problem at presentation. Thirty-four percent of visits among respondents were judged appropriate. In bivariate analysis, appropriate visits occurred significantly more often when a parent spoke to both a physician and a nonphysician (47%) prior to visiting the PED than when no advice was sought (29%; P < .05). In multivariate analysis, having a regular physician and being one of two children also contributed to appropriateness.
Conclusions:
Appropriate use of the PED was positively influenced by seeking prior advice from both a physician and family member, having a regular physician, and having prior child care experience.