Reconnecting Patients With Their Primary Care Provider

Sturm, James T.; Hirsh, Daniel A.; Weselman, Brad C.; Simon, Harold K.

doi:10.1177/0009922814540987

Cited by 34 publications

(25 citation statements)

References 33 publications

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“…With low caregiver health literacy found to be an independent predictor for higher ED use overall and for use of ED for NUC, interventions targeting health literacy skills in parents have been of great interest [ 16 – 20 ]. Preventive pediatric care guidelines by the American Academy of Pediatrics prescribe the discussion of many topics to be covered at each office visit to provide parent with anticipatory guidance [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Both characteristics have been previously identified as leading predictors for seeking care for NUC with children in the ED [ 23 ]. Other explanations for lack of impact may be that the added information about NUC was brief, presented only once, and competed with other preventive health messages to be discussed in the nursery (e.g., breastfeeding, SIDS prevention, and Shaken Baby Syndrome) therefore limiting likelihood of parental recall [ 20 , 22 ]. Indeed, discussing more than 8 anticipatory guidance topics during a pediatric health maintenance visit has not been found to be helpful [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

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Does Nursery-Based Intensified Anticipatory Guidance Reduce Emergency Department Use for Nonurgent Conditions in the First Month of Life? A Randomized Controlled Trial

Kamimura-Nishimura

Chaudhary

Olaosebikan

et al. 2016

International Journal of Pediatrics

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Objective. We aimed to evaluate the impact of an intensified anticipatory guidance program in the nursery on Emergency Department (ED) use for nonurgent conditions (NUCs) in the neonatal period. Methods. Parturient mothers of healthy newborns were randomized to an intervention group or control group. Baseline and 1-month follow-up knowledge surveys regarding newborn care were conducted. The primary outcome was the proportion of neonates who used the ED for a NUC. Secondary outcome was change in caregivers' knowledge on NUC. Results. Of a total of 594 mothers, 323 (54%) agreed to participate and were randomized to intervention (n = 170) or control (n = 153) group. Most were Hispanic (68%), single (61%), primiparous (39%), and without high school diploma (44%). 35 (21%) neonates in the intervention group and 41 (27%) in the control group were brought at least once for a NUC to the ED (p = 0.12). There was no statistically significant difference in within subject change on knowledge scores between the two study arms. Conclusions. Neonatal ED visits for NUCs occur frequently. This nursery-based intensified anticipatory guidance program had no statistically significant impact on neonatal ED use for NUC, nor on neonatal care-relevant knowledge among parturient mothers. Alternative modalities and timing of parental educational intervention may need to be considered. This trial is registered with Clinical Trials Number NCT01859065 (Clinicaltrials.gov).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does Nursery-Based Intensified Anticipatory Guidance Reduce Emergency Department Use for Nonurgent Conditions in the First Month of Life? A Randomized Controlled Trial

Kamimura-Nishimura

Chaudhary

Olaosebikan

et al. 2016

International Journal of Pediatrics

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“…Health planners and policy makers should expand the number of physicians participating in the FHN model to further reduce emergency department visits for low acuity problems. Additional health reforms successfully implemented in other jurisdictions could include open access scheduling in primary care offices[33], collaborative partnerships with primary care providers to develop new non-emergency department options for urgent care[34,35], and information provided to patients and their parents of their provider’s availability[36]. …”

Section: Discussionmentioning

confidence: 99%

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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“…Nevertheless, educational interventions at the point of care may represent opportunities for education on essential care follow-up between the provider and the child's caregiver(s). 24,35 At the same time, this approach is not without significant challenges. For example, educational efforts and teach-back can be a challenge to effectively standardize 24 and this speaks to the heterogeneity of health literacy needs that many caregivers may have—particularly in areas where diverse populations reside.…”

Section: Discussionmentioning

confidence: 99%

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

Taylor

Salyakina

2019

Population Health Management

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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.

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Reconnecting Patients With Their Primary Care Provider

Abstract: Intervention designed in cooperation with pediatricians was able to decrease nonurgent PED utilization and redirect patients to their PCP for future sick visits over a 12-month period.

Cited by 34 publications

References 33 publications

Does Nursery-Based Intensified Anticipatory Guidance Reduce Emergency Department Use for Nonurgent Conditions in the First Month of Life? A Randomized Controlled Trial

Does Nursery-Based Intensified Anticipatory Guidance Reduce Emergency Department Use for Nonurgent Conditions in the First Month of Life? A Randomized Controlled Trial

Understanding Low-Acuity Visits to the Pediatric Emergency Department

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

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