How community members and health professionals conceptualize medical emergencies: implications for primary care promotion

Wilkin, Holley A.; Tannebaum, Michael; Cohen, Elizabeth L.; Leslie, Travie; Williams, Nora A.; Haley, Leon L.

doi:10.1093/her/cys090

Cited by 3 publications

(3 citation statements)

References 34 publications

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“…This need for reassurance, belief that the primary care office lacks the tests and treatments necessary for their child’s condition, and trust in the medical expertise available at the pediatric emergency department, have also been highlighted in other studies[7,37–40]. As low health literacy has clear association with increased emergency department utilization[41], parental education could increase knowledge and confidence to manage common low-acuity problems with an appropriate ‘watch and wait’ approach[7].…”

Section: Discussionmentioning

confidence: 96%

Understanding Low-Acuity Visits to the Pediatric Emergency Department

et al. 2015

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BackgroundCanadian pediatric emergency department visits are increasing, with a disproportionate increase in low-acuity visits locally (33% of volume in 2008-09, 41% in 2011-12). We sought to understand: 1) presentation patterns and resource implications; 2) parents’ perceptions and motivations; and 3) alternate health care options considered prior to presenting with low-acuity problems.MethodsWe conducted a prospective cohort study at our tertiary pediatric emergency department serving two provinces to explore differences between patients with and without a primary care provider. During four, 2-week study periods over 1 year, parents of low-acuity visits received an anonymous survey. Presentation times, interventions, diagnoses and dispositions were captured on a data collection form linked to the survey by study number.ResultsParents completed 2,443 surveys (74.1% response rate), with survey-data collection form pairs available for 2,146 visits. Overall, 89.7% of respondents had a primary care provider; 68% were family physicians. Surprisingly, 40% of visits occurred during weekday office hours and 27.3% occurred within 4 hours of symptom onset; 67.5% of those early presenters were for injuries. Few parents sought care from their primary care provider (25%), health information line (20.7%), or urgent care clinic (18.5%); 36% reported that they believed their child’s problem required the emergency department. Forty-five percent required only a history, physical exam and reassurance; only 11% required an intervention not available in an office setting. Patients without a primary care provider were significantly more likely to present during weekday office hours (p = 0.003), have longer symptom duration (p<0.001), and not know of other options (p = 0.001).ConclusionsMany parents seek pediatric emergency department care for low-acuity problems despite their child having a primary care provider. Ensuring timely access to these providers may help reduce pediatric emergency department overuse. Educational initiatives should inform parents about low-acuity problems and where appropriate care can/should be accessed.

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Section: Discussionmentioning

confidence: 96%

Understanding Low-Acuity Visits to the Pediatric Emergency Department

et al. 2015

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“…29 Additionally, they may have less of an understanding of what symptoms do and do not require urgent attention. 34 Public transportation to clinics may be more difficult, making it more convenient to go to an ED instead. 31 Arranging for a clinic visit may require a more nuanced understanding of the healthcare system than simply presenting to the ED.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Visits to the Emergency Department for Urgent and Nonurgent Ocular Conditions

et al. 2017

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Purpose To determine the frequency of visits to emergency departments (EDs) for non-urgent and urgent ocular conditions and risk factors associated with utilization of the ED for non-urgent and urgent ocular problems. Design Retrospective longitudinal cohort analysis Participants All enrollees age ≥ 21 years old in a U.S. managed care network from 2001-2014. Methods We identified all enrollees who presented to an ED with ocular conditions identified by International Classification of Diseases, 9th Revision billing codes. We designated each diagnosis as “urgent”, “non-urgent”, or “other”. We assessed the frequency of ED visits for urgent and non-urgent ocular conditions and how they changed over time. Next, we performed multivariable Cox regression modeling to determine factors associated with visiting an ED for urgent or non-urgent ocular conditions. Main Outcome Measures Hazard ratios (HR) with 95% confidence intervals (CI) of visiting an ED for urgent or non-urgent ocular conditions. Results Of the 11,160,833 enrollees eligible for this study, 376,680 (3.4%) had ≥1 ED visit for an eye-related problem over a mean ± standard deviation of 5.4 ± 3.3 years follow-up. Among the 376,680 enrollees who visited the ED for ocular conditions, 86,473 (23.0%) had ≥1 ED visits with a non-urgent ocular condition and 25,289 (6.7%) had ≥1 ED visit with an urgent ocular condition. ED utilization for non-urgent ocular problems was associated with younger age (p<0.0001 for all comparisons), black race or Latino ethnicity (p<0.0001 for both), male sex (p<0.0001), lower income (p<0.0001 for all comparisons), and those who frequently presented to an ED for non-ophthalmologic medical problems in a given year (p<0.0001). Enrollees with established eye care professionals had a 10% reduced hazard of visiting the ED for non-urgent ocular conditions (adjusted HR=0.90 [CI 0.88-0.92], p<0.0001). Conclusions Nearly one quarter of all enrollees in this managed care network who visited the ED for ocular problems were diagnosed with non-urgent conditions. Better educating and incentivizing patients to seek care for non-urgent ocular diseases in an office-based setting instead of an ED could potentially yield considerable cost savings without adversely affecting health outcomes and allow EDs to better serve patients with more severe problems.

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“…For example, many Clínica Foianini staff initially interpreted the word as applying solely to those injuries treated by a traumatólogo (orthopedic surgeon), thus excluding many additional injury mechanisms and types. A handful of studies have sought to examine perceptions of medical emergencies, and how this influences ED and primary care utilization [16][17][18][19] ; however, the literature lacks similar studies on perceptions of trauma and how this could influence registry data collection. Preliminary results from a qualitative analysis of perceptions of trauma in Santa Cruz via focus groups and interviews showed varied interpretations of trauma among health care personnel, first responders, and community members (unpublished data).…”

Section: Discussionmentioning

confidence: 99%

Implementation of a Hospital-based Trauma Registry in Santa Cruz de la Sierra, Bolivia: Methodology, Preliminary Results, and Lessons learned

Mata¹,

Boeck²,

Blair³

et al. 2016

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Aim Five million annual global deaths are attributable to injuries. Yet, a lack of reliable data leaves the true magnitude of injuries unknown in many low- and middle-income countries (LMICs), like Bolivia. Trauma registries provide a means of acquiring these data. We sought to evaluate methodology, preliminary results, and lessons learned during the implementation of a pilot, hospital-based trauma registry at one facility in Santa Cruz de la Sierra, Bolivia. Materials and methods Data collection occurred from January to September 2015 at Clínica Foianini, a private, 50-bed, third-level facility in Santa Cruz. A paper trauma registry form based on the Panamerican Trauma Society's (ATS's) essential elements model was utilized. Trained nurses completed forms at a trauma patient's initial hospital presentation. Results were analyzed via descriptive statistics. Results The registry produced 91 forms over 8 months. An ICD-10 diagnosis code search of hospital visits showed 2,816 eligible patients, with a registry capture rate of 3.2%. Most were males (59.3%) in their mid-20s with head contusions (19.8%), penetrating/lacerating upper extremity (11.0%) or head (7.7%) wounds, or upper extremity fractures (6.6%). Many forms were missing critical data, with average omissions of 12.5 per form (26.0% of questions) and 23.7 per question (26.0% of subjects). Errors averaged 1.0 per form (2.1% of questions) and 2.0 per question (2.2% of subjects). Conclusion Early efforts to implement a paper-based trauma registry at one Bolivian hospital highlight areas for improvement, mainly within education, training, and oversight. Lessons learned will inform long-term objectives to make the registry a standard hospital program across the city, and eventually throughout Bolivia, arming decision-makers with data for targeted trauma initiatives that save lives. Clinical significance These results provide insight into trauma registry implementation in LMICs, which serves to further inform the Bolivian program and can be applied to comparable initiatives in similar settings. How to cite this article Boeck MA, Blair KJ, Foianini JE, Perry HB, Mata LV, Aboutanos MB, Haider AH, Swaroop M. Implementation of a Hospital-based Trauma Registry in Santa Cruz de la Sierra, Bolivia: Methodology, Preliminary Results, and Lessons learned. Panam J Trauma Crit Care Emerg Surg 2016;5(2):101-112.

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How community members and health professionals conceptualize medical emergencies: implications for primary care promotion

Cited by 3 publications

References 34 publications

Understanding Low-Acuity Visits to the Pediatric Emergency Department

Understanding Low-Acuity Visits to the Pediatric Emergency Department

Factors Affecting Visits to the Emergency Department for Urgent and Nonurgent Ocular Conditions

Implementation of a Hospital-based Trauma Registry in Santa Cruz de la Sierra, Bolivia: Methodology, Preliminary Results, and Lessons learned

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