Health Care Access Barriers Bring Children to Emergency Rooms More Frequently: A Representative Survey

Abstract

Children may visit the emergency department (ED) regularly in part because they and their caregivers may be experiencing barriers to appropriate and timely pediatric care. However, assessing the wide range of potential barriers to access to care that children and their caregivers may experience is often a challenge. The objective of this study was to assess the barriers to pediatric health care reported by caregivers and to examine the association between those reported barriers to care with the frequency of children's ED visits in the past 12 months. Assessment of ED utilization and access to care barriers was made through a telephone interview survey conducted as part of a broader Community Health Needs Assessment in 2015. A weighted community sample of adult caregivers (N = 1057) of children between the ages of 0-17 residing in Miami-Dade, Broward, and Palm Beach counties, Florida were contacted. This study found that multiple ED visits (≥2 vs. 0) in the past 12 months by a child were most strongly associated with access to care barriers attributed to language and culture (relative risk [RR] = 2.51), trouble finding a doctor (RR = 1.86), scheduling an appointment (RR = 1.68), and transportation access (RR = 1.73). These findings suggest that access to care barriers experienced by households may exacerbate the risk of a child experiencing repeated visits to the ED in a year. Findings are discussed further in the context of actionable population health management strategies to reduce risk of frequent ED utilization by children.

Characteristics of frequently attending children in hospital emergency departments: a systematic review

“…Caregivers who experienced cultural or language barriers were 5.8 times more likely to take their child to the ED more than twice within the period of 12 months compared with children who did not have caregivers who experienced cultural or language barriers. 29 Transport challenges were also correlated with numerous ED visits. 22 …”

The terminology of social emergency medicine: Measuring social determinants of health, social risk, and social need

“…11 In addition, studies have shown a strong association between SDoH and ED utilization. 12,13 For example, during the first year of life, children who experienced homelessness were significantly more likely to visit the ED. 14 Using insurance billing data for an adult sample, 1 study found that patients with incomes less than the national median had a significantly increased risk of ED visits for hypoglycemia in the last week of the month (when food benefits would be expected to run out) compared to earlier weeks.…”

“…A recent systematic review found a high prevalence of material needs among patients in several ED studies 11 . In addition, studies have shown a strong association between SDoH and ED utilization 12,13 . For example, during the first year of life, children who experienced homelessness were significantly more likely to visit the ED 14 .…”

Low Income and Nonadherence to Health Supervision Visits Predispose Children to More Emergency Room Utilization

“…Previous studies have found that children who live below the poverty line are prone to have poor health and chronic health conditions, which require more medical attention. 20 However, these children may not be able to access preventive care due to lack of transportation 21 or inability of the parents to take time off if the scheduled medical appointment conflicts with their working hours.…”