Reliance on Acute Care Settings for Health Care Utilization

Goyal, Monika K.; Richardson, Troy; Masonbrink, Abbey; Reed, Jennifer L.; Hall, Matt; Neuman, Mark I.

doi:10.1097/pec.0000000000001924

Cited by 6 publications

(7 citation statements)

References 40 publications

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“…Prior studies have proposed health education forums and offering preventive primary care in nontraditional settings that may be more accessible. 32 We hope to use this study and future studies to identify similar interventions relevant to NYC.…”

Section: Discussionmentioning

confidence: 99%

“…30,31 However, overreliance on EDs can impact continuity of care for pediatric patients, potentially harming the coordination of care for future visits and access to preventive care. 32,33 Prior literature suggests that in addition to financial resources, increased reliance on EDs as primary care for children has been associated with public/uninsured insurance status, race/ethnicity, education, and employment status. [33][34][35] As evidenced by the plethora of prior literature, these social issues are not novel.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology of pediatric trauma and fractures during and beyond the COVID-19 pandemic

Butler

Abbott

Mengsteab

et al. 2023

Journal of Children's Orthopaedics

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Purpose: Previous literature has shown decreases in pediatric trauma during the COVID-19 outbreak, but few have analyzed beyond the peak of the pandemic. This study assesses the epidemiology of pediatric trauma cases in a high-volume teaching hospital in New York City before, during, and after the height of the COVID-19 pandemic. Methods: Institutional data on pediatric trauma orthopedic cases from January 1, 2018 to November 30, 2021 were extracted. The following time frames were studied: (1) April 1–June 22 in 2018 and 2019 (pre-pandemic), (2) April 1–June 22, 2020 (peak pandemic), and (3) April 1–June 22, 2021 (post-peak pandemic). Inferential statistics were used to compare patient and trauma characteristics. Results: Compared to the pre-pandemic cohort (n = 6770), the peak pandemic cohort (n = 828) had a greater proportion of fractures (p < 0.01) and had a significantly decreased overall traumas per week rate (p < 0.01) and fractures per week rate (p < 0.01). These decreased trauma (p < 0.01) and fracture rates (p < 0.01) persisted for the post-peak pandemic cohort (n = 2509). Spatial analysis identified zip code clusters throughout New York City with higher rates of emergency department presentation during the peak pandemic compared to pre-pandemic, and these areas aligned with lower-income neighborhoods. Conclusion: During the peak of the pandemic, overall trauma and fracture volumes decreased, the types of prevalent injuries changed, and neighborhoods of different economic resources were variably impacted. These trends have mostly persisted for 12 months post-peak pandemic. This longitudinal analysis helps inform and improve long-term critical care and public health resource allocation for the future. Level of evidence: Level III

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Epidemiology of pediatric trauma and fractures during and beyond the COVID-19 pandemic

Butler

Abbott

Mengsteab

et al. 2023

Journal of Children's Orthopaedics

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“…For many adolescents, there is a high reliance on the ED and it may be their only source of care. 13,14 In addition, adolescents who visit the ED often engage in high-risk behaviors. 15,16 This makes it particularly concerning that rates of STI screening were so low.…”

Section: Discussionmentioning

confidence: 99%

“…Sexually transmitted infection testing overall was low (14.7%), but given that only half of patients had a documented sexual history, it raises concerns that need for testing may have been missed. For many adolescents, there is a high reliance on the ED and it may be their only source of care 13,14 . In addition, adolescents who visit the ED often engage in high-risk behaviors 15,16 .…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in the Emergency Department Evaluation of Adolescent Girls

et al. 2022

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Objective: Racial disparities and differences exist in emergency care.Obtaining a sexual history is standard of care for adolescents with abdominal pain. Testing for sexually transmitted infections (STIs) and pregnancy should be based on historical findings. The objective of this study was to determine whether differential care was provided to adolescent female patients with abdominal pain based on patient race or healthcare provider characteristics by evaluating the documentation of sexual history, STI testing, and pregnancy testing.Methods: This was a retrospective chart review of female patients between the ages of 14 and 18 years with abdominal pain presenting to a pediatric emergency department. Patient and provider characteristics, sexual history documentation, STI, and pregnancy testing were abstracted. Data were analyzed using χ 2 test and logistic regression model.Results: Eight hundred eighty-six encounters were included in the analysis.Median patient age was 16 years (range, 14-18 years); 359 (40.5%) were non-White. Differential care was provided. Non-White patients compared with White patients were more likely to have a documented sexual history (59.9% vs 44.0%, P < 0.001), STI testing (24.8% vs 7.8%, P < 0.001), and pregnancy testing (76.6% vs 66.2%, P < 0.001). Among sexually active female patients, the racial disparity for STI testing persisted ( P = 0.010). Provider type and sex did not result in differences in sexual history documentation, STI, or pregnancy testing for non-White compared with White patients ( P > 0.05).Conclusions: Differential care was provided to non-White adolescents with abdominal pain compared with White adolescents. They were more likely to have a documented sexual history, STI testing, and pregnancy testing. Healthcare provider characteristics did not impact patient care. This racial disparity resulted in better medical care for non-White adolescents, but this may be the consequence of underlying implicit bias.

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“…5 Many adolescents do not have an established primary care home and, therefore, use the ED as their primary source of health care. 6 Multiple studies 3,7 have demonstrated suboptimal contraceptive use and high rates of unintended pregnancy risk in the adolescent ED population. Thus, we conducted this secondary analysis of a multicenter study to measure and describe the use of contraception and pregnancy risk among adolescents accessing the ED for care.…”

Section: Introductionmentioning

confidence: 99%

Contraception Use and Pregnancy Risk Among Adolescents in Pediatric Emergency Departments

Canter,

Reed,

Palmer

et al. 2024

JAMA Netw Open

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ImportanceUnintended pregnancy is a major health risk for adolescents in the US, and adolescents face many barriers to obtaining effective and reliable contraception.ObjectiveTo measure and describe the use of contraception, pregnancy risk index (PRI), and emergency contraception (EC) prescriptions among female adolescents accessing the emergency department (ED) for care.Design, Setting, and ParticipantsThis cross-sectional study is a planned secondary analysis of a multicenter trial from April 2021 through April 2022 that used a tablet-based, content-validated, confidential sexual health survey at 6 urban, pediatric tertiary care EDs affiliated with the Pediatric Emergency Care Applied Research Network. Participants were individuals aged 15 to 21 years presenting to the ED who completed the confidential sexual health survey and indicated female sex assigned at birth and prior penile-vaginal sexual intercourse. Data analysis was performed from January 2023 to February 2024.Main Outcomes and MeasuresThe primary outcomes were the type and proportion of contraception use, the PRI, and provision of EC. Separate multivariable logistic regression models were performed to identify sociodemographic factors associated with these outcomes.ResultsA total of 1063 participants (median [IQR] age, 17.5 [16.5-18.3] years) were included in this analysis; 219 (20.8%) identified as Hispanic, 464 (44.1%) identified as non-Hispanic Black, 308 (29.3%) identified as non-Hispanic White, and 61 (5.8%) identified as other races and ethnicities. In total, 756 participants (71.1%) reported contraception use during their last sexual encounter. Long-acting reversible contraception use (LARC) was the least used (164 participants [15.4%]), and 307 (28.9%) reported no contraception use. Sociodemographic factors associated with overall contraception use, and LARC use specifically, included insurance and race and ethnicity. The overall PRI was 7.89, or an expected 8 pregnancies per 100 female individuals per year. Although 108 participants (10.2%) were eligible for EC, EC was ordered for only 6 (5.6%) of those eligible.Conclusions and RelevanceIn this cross-sectional study of sexually active adolescents presenting to the ED, the majority of participants reported using at least 1 form of contraception; however, LARCs were the least used option, and 28.9% of participants reported no contraceptive use. The unintended pregnancy risk was almost 8% in the study population. Few patients eligible for EC received it. These data suggest a high need and potential opportunity for provision of contraception services in the ED setting.

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Reliance on Acute Care Settings for Health Care Utilization

Cited by 6 publications

References 40 publications

Epidemiology of pediatric trauma and fractures during and beyond the COVID-19 pandemic

Epidemiology of pediatric trauma and fractures during and beyond the COVID-19 pandemic

Racial Disparities in the Emergency Department Evaluation of Adolescent Girls

Contraception Use and Pregnancy Risk Among Adolescents in Pediatric Emergency Departments

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