Emergency health care use and follow-up among sociodemographic groups of children who visit emergency departments for mental health crises

Newton, Amanda S; Rosychuk, Rhonda J.; Dong, Kathryn; Curran, Janet; Slomp, Mel; McGrath, Patrick J.

doi:10.1503/cmaj.111697

Cited by 46 publications

(53 citation statements)

References 24 publications

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“…We decided a priori to include age, sex, race, ethnicity, region, urban status, and year in the model, as they have been previously demonstrated to be associated with differences in both ED and psychiatric care. 3,6,7,11,12,16,[19][20][21][22][23][24] For the length of stay (LOS) analysis as our secondary outcome, we tested for trend the median visit length. Median LOS is used in place of the mean LOS as values were not normally distributed.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Outpatient access to psychiatric care for children may be limited, especially in certain at-risk socioeconomic groups. 6,[11][12][13][14] While the PECARN study and several Canadian studies have suggested that socioeconomic factors may be associated with high odds of ED psychiatric visits, 3,12,[15][16][17] no study has evaluated these factors using nationally representative United States data. The specific focus of this study was on sociodemographic factors and their effect on odds of ED visits.…”

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confidence: 99%

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Trends in Pediatric Visits to the Emergency Department for Psychiatric Illnesses

Pittsenbarger

Mannix

2013

Academic Emergency Medicine

124

106

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Objectives: While recent studies have demonstrated an overall increase in psychiatric visits in the emergency department (ED), none have focused on a nationally representative pediatric population. Understanding trends in pediatric psychiatric ED visits is important because of limited outpatient availability of pediatric specialists, as well as long wait times for psychiatric appointments. The study aim was to evaluate the trends in ED psychiatric visits for children between 2001 and 2010 with comparison by sociodemographic characteristics.Methods: This was a retrospective, cross-sectional analysis of ED psychiatric visits for children < 18 years of age using the National Hospital Ambulatory Medical Care Survey (NHAMCS). Visits were identified by International Classification of Diseases, Ninth Revision (ICD-9), codes. Outcome measures included frequency of visits for children with psychiatric diagnosis codes and odds and adjusted odds of psychiatric visits controlling for temporal, demographic, and geographic factors.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Trends in Pediatric Visits to the Emergency Department for Psychiatric Illnesses

Pittsenbarger

Mannix

2013

Academic Emergency Medicine

124

106

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“…Further, Newton et al [10] have reported on the effect of sociodemographic factors on the number of visits to emergency services by mental health patients, primarily focusing on sociodemographic status and risk of an individual's return to the emergency department. Hefflinger and Hinshaw [7] have reported that stigma exists at professional and institutional levels and is the reason for low health care utilization among children and adolescents with mental disorders seeking mental health services.…”

Section: Resultsmentioning

confidence: 99%

“…With increasing mental disorder diagnoses and health care costs, it is essential to examine this effect on children diagnosed with a PD experiencing physical disorders. While Newton et al [10] have examined the mental diagnoses in emergency departments in Alberta, the present study extends this conceptualization to include overall health care utilization patterns by children and youth under the age of 18. In this study we examine the health care service utilization for physical disorders of children with psychiatric diagnosis across three health care settings; physician billing, ambulatory services, and inpatient/emergency services.…”

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confidence: 99%

Treatment of physical disorder in children with mental disorder: A health care utilization study

Ghuttora

Cawthorpe

2013

JHA

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Objective: This study examines, across physician billing, ambulatory and inpatient/emergency datasets, the health care utilization of individuals under the age of 18 years for physical disorders in relationship to the existence of a physician assigned psychiatric disorder. Methods:A retrospective sample of all visit records from three datasets (physician billing, ambulatory records, and inpatient/emergency records n = 12687710) was constructed for cases (n = 26392) and comparisons (n = 205281). The mean number of visits for physical disorders (excluding psychiatric disorders) was calculated for groups defined as cases and comparisons with and without psychiatric disorders.Results: Among Cases and Comparisons with and without psychiatric disorders, physical disorders are significantly greater for any with psychiatric disorder over the 16 years study period in both physician billing and ambulatory datasets. This result differs in the inpatient/emergency dataset in that cases have about 1/3 the number of admissions for physical diagnoses. Conclusion:It was unexpected that cases with a psychiatric diagnosis in the physician billing dataset had fewer physical disorder related inpatient and emergency admissions. We explore the putative explanations for the observed treatment bias related to physical disorders of children with psychiatric disorders.

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“…Les taux de suivi chez les enfants des Premières Nations étaient particulièrement bas, hors de proportion avec ceux enregistrés chez les autres enfants. Ainsi, le temps d'attente médian avant les consultations de suivi chez les enfants des Premières Nations était de 39 jours (IC à 95 %: 32-48) contre 16 jours chez les enfants de familles non bénéficiaires de subvention (IC à 95 %: [14][15][16][17][18][19]; ces derniers avaient d'ailleurs les délais d'attente les plus courts pour un suivi après une consultation dans un SU. Conclusions: Il ressort de l'étude des écarts sociodémogra-phiphes très nets en ce qui concerne les taux de consultation au SU ainsi que le nombre de consultations médicales de suivi et le temps d'attente avant celles-ci.…”

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Emergency Health Care Use among Sociodemographic Groups of Children Presenting to Emergency Departments for Self-Harm in Alberta

Newton

Tsang

Rosychuk

2015

CJEM

Self Cite

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Objective: To examine sociodemographic variations among children <18 years in (1) rates of self-harm visits to emergency departments (EDs) and (2) physician follow-up after the selfharm visit in Alberta. Methods: A retrospective, population-based cohort (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011) of ED visits for self-harm by individuals <18 years was conducted using administrative databases from Alberta, Canada. Individuals were grouped by First Nations status or type of health care premium subsidy (family receipt of government subsidy, human services program subsidy, no subsidy received). Visits from 104 EDs were summarized by crude and directly standardized visit rates (DSVRs) per 100,000 individuals. Kaplan-Meier estimates for median estimated time to physician follow-up were calculated with 95% confidence intervals (CIs). Results: During the study period, visit rates decreased with the exception of children from families receiving government-sponsored program subsidy (DSVRs 163/ 100,000 to 250/100,000; p = 0.032). First Nations children had disproportionately fewer follow-up visits compared to other children. The median time to follow-up for First Nations children was 39 days (95% CI: 32, 48) compared to 16 days for children from families receiving no subsidy (95% CI: 14, 19), who had the shortest follow-up time after an ED visit. Conclusions: Sociodemographic differences were evident in ED visit rates as well as the number of and time to physician followup visit. The disparities experienced by First Nations children in the follow-up period highlight an opportunity for culturallygrounded risk and needs assessment in the ED to determine and facilitate timely and appropriate follow-up care.

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Emergency health care use and follow-up among sociodemographic groups of children who visit emergency departments for mental health crises

Cited by 46 publications

References 24 publications

Trends in Pediatric Visits to the Emergency Department for Psychiatric Illnesses

Trends in Pediatric Visits to the Emergency Department for Psychiatric Illnesses

Treatment of physical disorder in children with mental disorder: A health care utilization study

Emergency Health Care Use among Sociodemographic Groups of Children Presenting to Emergency Departments for Self-Harm in Alberta

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