After-Hours Pediatric Care Compared With Emergency Department Care

Goodrich, S.; Evans, Joseph; Gress, Todd; Werthammer, Joseph

doi:10.1177/0009922815574678

Cited by 5 publications

(6 citation statements)

References 7 publications

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“…Public insurance was associated with increased odds of repeat use (aOR, 2.01 [95% CI, 1.89-2.13]), whereas having no insurance was associated with very low odds, compared with private insurance (aOR, 0.23 [95% CI, 0.18-0.29]). Children with chronic conditions were substantially more likely to be frequent users compared with children without a chronic condition (noncomplex chronic: aOR, 6 ). There was no sex association for higher levels of ED use.…”

Section: Resultsmentioning

confidence: 99%

“…4,5 From an economic perspective, ED visits are substantially more expensive than visits to primary care providers. [6][7][8] From an ED quality perspective, high usage rates can lead to overcrowding with long waits for families and the potential for delays in care for critically ill children. 4,9 Emergency departments are also not designed to provide the continuity of care and preventive services that are offered in a primary care setting.…”

mentioning

confidence: 99%

“…While access to ED care is essential, the high rate of use raises concerns centered on medical costs and quality of care 4,5 . From an economic perspective, ED visits are substantially more expensive than visits to primary care providers 6–8 . From an ED quality perspective, high usage rates can lead to overcrowding with long waits for families and the potential for delays in care for critically ill children 4,9 .…”

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confidence: 99%

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Frequent Emergency Department Use by Children

et al. 2019

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Objectives: Frequent use of the emergency department (ED) is often targeted as a quality improvement metric. The objective of this study was to assess ED visit frequency by the demographic and health characteristics of children who visit the ED to better understand risk factors for high ED utilization. Methods:The majority of pediatric ED services in Rhode Island are provided by a hospital network that includes the state's only children's hospital. Using 10 years of data (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) from this statewide hospital network, we examined ED use in this network for all children aged 0 to 17 years. Patients' home addresses were geocoded to assess their neighborhood characteristics.Results: Between 2005 and 2014, 17,844 children visited 1 or more of the network EDs at least once. In their year of maximum use, 67.8% had only 1 ED visit, 20.1% had 2 visits, 6.9% had 3 visits, and 5.2% had 4 or more visits. In the adjusted multinomial logistic regression model, age, race/ ethnicity, language, insurance coverage, medical complexity, neighborhood risk, and distance to the ED were found to be significantly associated with increased visit frequency.Conclusions: Risk factors for frequent ED use by children include age, race/ethnicity, language, insurance coverage, medical complexity, neighborhood risk, and distance to the hospital. To decrease frequent pediatric ED use, improved medical management of complex medical problems is needed, but it is also essential to address modifiable social determinants of health care utilization in this population.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Frequent Emergency Department Use by Children

et al. 2019

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“…A multinational study exploring the diagnostic scope in OOH primary care in eight European countries found respiratory problems in 14–44% of children under the age of 18 years, general and non-specific complaints in 11–24%, and ear problems in up to 13% [3]. In an OOH paediatric clinic in the US, Goodrich et al found that 26% of children under the age of 15 years presented with upper respiratory infection and 14% with otitis media or related conditions [18]. These figures are very similar to our findings although the age group investigated in our study was younger.…”

Section: Discussionmentioning

confidence: 99%

Preschool children in Danish out-of-hours primary care: a one-year descriptive study of face-to-face consultations

et al. 2019

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Background The demand for out-of-hours (OOH) primary care has increased during the last decades, with a considerable amount of contacts for young children. This study aims to describe the reasons for encounter (RFE), the most common diagnoses, the provided care, and the parental satisfaction with the general practitioner (GP) led OOH service in a Danish population of children (0–5 years). Methods We conducted a one-year cross-sectional study based on data for 2363 randomly selected contacts concerning children from a survey on OOH primary care including 21,457 patients in Denmark. For each contact, the GPs completed an electronic pop-up questionnaire in the patient’s medical record. Questionnaire items focussed on RFE, health problem severity, diagnosis, provided care, and satisfaction. The parents subsequently received a postal questionnaire. Results The most common RFE was non-specific complaints (40%), followed by respiratory tract symptoms (23%), skin symptoms (9%), and digestive organ symptoms (8%). The most common diagnosis group was respiratory tract diseases (41%), followed by general complaints (19%) and ear diseases (16%). Prescriptions were dispensed for 27% of contacts, and about ¾ were for antibiotics. A total of 12% contacts concerned acute otitis media; antibiotics were prescribed in 70%. A total of 38% of contacts concerned fever, and ¼ got antibiotics. A total of 7.4% were referred for further evaluation. The parental satisfaction was generally high, but 7.0% were dissatisfied. Dissatisfaction was correlated with low prescription rate. Conclusion Respiratory tract diseases were the most common diagnoses. The GPs at the OOH primary care service referred children to hospital in 7.4% of the face-to-face consultations, and the provided care was evaluated as non-satisfying by only 7.0% of the parents. Clinical implications of the findings mean room for less prescription of antibiotic to children with ear diseases and a need for research in factors related to dissatisfaction.

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“…Younger age was found to be a risk factor in driving the nonurgent ED use in this review 9 . From a cost-benefit analysis, median costs related to treatment for common diagnoses in an ED can be 4 to 5 times higher in comparison with similar care provided for the same conditions in a pediatric clinic 10,11 …”

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confidence: 99%

Do Unmet Health Needs Drive Pediatric Emergency Department Utilization?

et al. 2020

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Lack of access to basic health services is thought to increase emergency department (ED) utilization. This study assessed the relationship between unmet health care needs and pediatric ED utilization in the United States. Methods:The National Survey of Children's Health was used (2016-2017; n = 71,360). Parent/guardians reported number of ED visits and the presence of unmet health needs (medical, dental, mental health, vision, hearing, other) in the last 12 months. Associations were analyzed using multinomial logistic regression modeling and accounted for the weighting and complex survey design of the National Survey of Children's Health. Results:Children with 2 or more unmet health needs had 3.72 times (95% confidence interval, 2.25-6.16) risk of ≥2 ED visits when compared with those with 0 unmet health needs. This risk became nonsignificant when adjusted for race, ethnicity, age, insurance, having asthma, current medication status, health description, number of preventative health visits, and place to go for preventative health (aRR, 1.77; 95% confidence interval, 0.96-3.27). The adjusted association was also nonsignificant for specific types of unmet needs. Race, insurance status, age 0 to 3 years, current medication status, having asthma, ≥2 preventative visits, and poorer health were associated with ≥2 ED visits.Conclusions: Unmet health needs were not found to be a significant driving force for ED utilization. Other factors were found to be more strongly associated with it. Future studies to understand the perception, motives, and complex interaction of various factors leading to ED use in high-risk populations may optimize care for these children.

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After-Hours Pediatric Care Compared With Emergency Department Care

Cited by 5 publications

References 7 publications

Frequent Emergency Department Use by Children

Frequent Emergency Department Use by Children

Preschool children in Danish out-of-hours primary care: a one-year descriptive study of face-to-face consultations

Do Unmet Health Needs Drive Pediatric Emergency Department Utilization?

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