Association between Enhanced Access Services in Pediatric Primary Care and Utilization of Emergency Departments: A National Parent Survey

Abstract

Objectives To measure the prevalence of enhanced access services in pediatric primary care and to assess whether enhanced access services are associated with lower emergency department (ED) utilization. Study design Internet-based survey of a national sample of parents (n=820, response rate 41%). We estimated the prevalence of reported enhanced access services and ED use in the prior 12 months. We then used multivariate negative binomial regression to assess associations between enhanced access services and ED use. Results The majority of parents reported access to advice by telephone during office hours (80%), same-day sick visits (79%), and advice by telephone outside office hours (54%). Fewer than one-half of parents reported access to their child’s primary care office on weekends (47%), after 5:00 pm on any night (23%), or by email (13%). Substantial proportions of parents reported that they did not know if these services were available (7-56%, depending on service). Office hours after 5:00 pm on ≥5 nights a week was the only service significantly associated with ED utilization in multivariate analysis (adjusted incidence rate ratio: 0.51 [95% CI 0.28-0.92]). Conclusions The majority of parents report enhanced access to their child’s primary care office during office hours, but many parents do not have access or do not know if they have access outside of regular office hours. Extended office hours may be the most effective practice change to reduce emergency department use. Primary care practices should prioritize the most effective enhanced access services and communicate existing services to families.

Characteristics of Recurrent Utilization in Pediatric Emergency Departments

“…Of these resources, extended office hours have been the most effective way to reduce ED use in children. 30 Further study is needed to assess the cost-effectiveness of ED diversion tactics to primary and community care for children.…”

Factors Associated With Potentially Preventable Pediatric Admissions Vary by Diagnosis: Findings From a Large State

“…This scenario requires both an astute caregiver and quick access to a sick appointment, which is limited in small or busy practices and those with no after-hours appointments. 19 Similarly, appendicitis rupture can only be prevented with early diagnosis and referral for surgical management. Qualitative exploration with parents and physicians about progression versus early prevention of each of the 5 conditions may provide areas for systemic improvement or further research into their prevention.…”

Disentangling the Linkage of Primary Care Features to Patient Outcomes: A Review of Current Literature, Data Sources, and Measurement Needs

“…43,44 Likewise, access to after-hours care coordinated with the primary care provider is associated with lower rates of hospitalization and emergency department use, greater patient satisfaction and fewer unmet medical needs. [45][46][47][48] Continuity also has various components, including informational continuity (the availability of a patient's health information at the point of care), continuity with the same practice over time, and interpersonal continuity with the same clinician over time. 4,5,49,50 These last two aspects are the concepts most often referenced in primary care research; they have been associated with lower hospitalization rates, [51][52][53][54][55][56] lower complication rates for patients with chronic conditions, 55 fewer emergency room visits, 57,58 lower total costs 53 and lower episodebased costs for chronic conditions.…”