ePosters: Health Policy and Health Services Research, Patient Safety and Quality
693 - Pediatric Non-Urgent Emergency Department Visits and Prior Care-Seeking at Primary Care
Thursday, May 14, 2020
Location: Majestic Ballroom: Majestic
Background and Objectives: Reducing non-urgent visits to emergency departments (ED) by children is an opportunity to reduce health care costs. Prior studies have investigated child and family sociodemographic characteristics associated with non-urgent ED visits. We aimed to examine how perceptions of care options affect care-seeking decisions prior to non-urgent ED visits.
Methods: We performed a cross-sectional survey of caregivers of children presenting to a pediatric emergency department during weekday business hours and triaged as low acuity. Our primary outcome variable of interest was whether caregivers had or had not sought advice from their primary care physician (PCP) prior to their ED visit. We compared caregiver sociodemographic characteristics, perceptions of primary care, and relative preference in care sites (ED vs PCP) for caregivers who had versus had not sought care from their PCP prior to ED visit using chi-squared tests, Fischer exact tests, and Kruskal-Wallis tests. We examined the odds of having sought care from a PCP prior to ED using three multivariable logistic regression models including (1) caregiver sociodemographic characteristics, (2) caregiver characteristics and primary care perceptions, and (3) caregiver characteristics and relative care site preference.
Results: Of 140 respondents, 64 (45%) reported seeking care from their child’s PCP prior to presenting to the ED, while 55% did not. In unadjusted analysis, children insured by Medicaid or CHIP, caregivers identifying as Black, and caregivers who had not entered college were less likely to seek care from their PCP before presenting to the ED (p<0.005, each). Caregivers who had sought care from their PCP were more likely to prefer their PCP relative to the ED in terms of ease of travel, cost, and wait times (p<0.001, all). When including these stated preferences in a multivariable model, child insurance, caregiver race, and caregiver education were no longer associated with odds of having sought care at PCP prior to ED visit.
Conclusion: Caregivers who sought care from their PCP prior to an ED visit were more likely to view their PCP as preferable to the ED in terms of travel, cost, and wait times. Additionally, sociodemographic differences in likelihood of seeking care from a child’s PCP prior to non-urgent ED visits appeared to be explained by differential experiences within primary care compared to the ED.