Influence of awareness and availability of medical alternatives on parents seeking paediatric emergency care

Abstract

Aims: Direct seeking of care at paediatric emergency departments may result from an inadequate awareness or a short supply of medical alternatives. We therefore evaluated the care-seeking patterns, availability of medical options and initial medical assessments – with overall reference to socioeconomic status – of parents at an urban paediatric emergency department in a Scandinavian country providing free paediatric healthcare. Methods: The parents of children assessed by paediatric emergency department physicians at a Swedish university hospital over a 25-day winter period completed a questionnaire on recent medical contacts and their reasons for attendance. Additional information was obtained from ledgers, patient records and population demographics. Results: In total, 657 of 713 eligible patients (92%) were included. Seventy-nine per cent of their parents either failed to or managed to establish medical contact before the emergency department visit, whereas 21% sought care with no attempt at recent medical contact. Visits with a failed telephone or primary care contact (18%) were more common outside office hours (p=0.014) and were scored as less urgent (p=0.014). A perceived emergency was the main reason for no attempt at medical contact before the visit. Direct emergency department care-seeking was more common from the city district with the lowest socioeconomic status (p=0.027). Conclusions: Although most parents in this Swedish study tried to seek medical advice before attending a paediatric emergency department, perceived emergency, a short supply of telephone health line or primary care facilities and lower socioeconomic status contributed to direct care-seeking by almost 40% of parents. Pre-hospital awareness and the availability of medical alternatives with an emphasis on major differences in socioeconomic status should therefore be considered to further optimize care-seeking in paediatric emergency departments.

Keywords

Children emergency department paediatrics primary care seeking behaviour socioeconomic status telephone health line urgency

Get full access to this article

View all access options for this article.

References

Pittes

Pines

Handrigan

et al

National trends in emergency department occupancy 2001 to 2008: Effect of inpatient admissions versus emergency department practice intensity. Ann Emerg Med 2012;60:679–86.

Pines

Hilton

Weber

et al

International perspectives on emergency department crowding. Acad Emerg Med 2011;18:1358–70.

Sills

Fairclough

Ranade

et al

Emergency department crowding is associated with decreased quality of care for children. Pediatr Emerg Care 2011;27:837–45.

Swedish National Board of Health and Welfare, www.socialstyrelsen.se/publikationer2014/2014-12-4 (2014, accessed November 2015).

Backman

Blomqvist

Lagerlund

et al

Physician assessment of appropriate healthcare level among nonurgent patients. Am J Manag Care 2010;16:361–8.

Göransson

De Waern

Lindmarker

Patients’ pathway to emergency care: Is the emergency department their first choice of care?

Eur J Emerg Med 2013;20: 45–50.

Pileggi

Raffaele

Angelillo

IF.

Paediatric utilization of an emergency department in Italy. Eur J Public Health 2006;16:565–9.

Hendry

Beattie

Heaney

Minor illness and injury: Factors influencing attendance at a paediatric accident and emergency department. Arch Dis Child 2005;90:629–33.

Halfon

Newacheck

Wood

et al

Routine emergency department use for sick care by children in the United States. Pediatrics 1996;98:28–34.

10.

Ellbrant

Åkeson

Karlsland Åkeson

Pediatric emergency department management benefits from appropriate early redirection of nonurgent visits. Pediatr Emerg Care 2015;31:95–100.

11.

Hummel

Mohler

Clemens

et al

Why parents use the emergency department during evening hours for nonemergent pediatric care. Clin Pediatr 2014;53:1055–61.

12.

Brousseau

Hoffmann

Nattinger

et al

Quality of primary care and subsequent pediatric emergency department utilization. Pediatrics 2007;119:1131–8.

13.

Johnson

Rimsza

ME.

The effects of access to pediatric care and insurance coverage on emergency department utilization. Pediatrics 2004;113:483–7.

14.

Statistik Malmö Stad, http://malmo.se/Kommun-politik/Fakta-och-statistik/Befolkning.html (2013, accessed October 2016).

15.

Van Ierland

Seiger

Van Veen

et al

Self-referral and serious illness in children with fever. Pediatrics 2012;129:643–51.

16.

Rinderknecht

Matykiewicz

et al

Referral to the emergency department by a primary care provider predicts severity of illness. Pediatrics 2010;126:917–24.

17.

Kubicek

Liu

Beaudin

et al

A profile of nonurgent emergency department use in an urban pediatric hospital. Pediatr Emerg Care 2012;28:977–84.

18.

Scolnik

Keogh

Tuffman

et al

Parents may know best! A pilot study suggest that children of parents who do not have contact with health care professionals before attending the emergency department are triaged as more urgent. Paediatr Child Health 2011;16:25–8.

19.

Fieldston

Alpern

Nadel

et al

A qualitative assessment of reasons for nonurgent visits to the emergency department: Parent and health professional opinions. Pediatr Emerg Care 2012;28:220–5.

20.

Scarfone

Luberti

Mistry

RD.

Outcomes of children referred to an emergency department by an after-hours call center. Pediatr Emerg Care 2004;20:367–72.

21.

Kempe

Bunik

Ellis

et al

How safe is triage by an after-hours telephone call center?

Pediatrics 2006;118:457–63.

22.

Barber

King

Monroe

et al

Evaluation of emergency depament referrals by telephone triage. Pediatrics 2000;105:819–21.

23.

Al-Abdullah

Plint

Shaw

et al

The appropriateness of referrals to a pediatric emergency department via a telephone health line. CJEM 2009;11:139–48.

24.

Matsumura

Ohshige

Tsuchida

et al

The increasing use of pediatric emergency facilities in the evening. Pediatr Emerg Care 2007;23:142–7.

25.

Norredam

Krasnik

Sorensen

et al

Emergency room utilization in Copenhagen: A comparison of immigrant groups and Danish-born residents. Scand J Public Health 2004;32:53–9.

26.

DeShaw

PJ.

Use of the emergency department by Somali immigrants and refugees. Minn Med 2006;89:42–5.

27.

Hargraves

Friedland

Gothard

et al

Impact on use of health services by international migrants: Questionnaire survey of inner city London A&E attenders. BMC Health Serv Res 2006;6:153.

28.

Larson

Halfon

Family income gradients in the health and health care access of US children. Matern Child Health J 2010;14:332–42.

29.

Seid

Stevens

Varni

JW.

Parents’ perceptions of pediatric primary care quality: Effects of race/ethnicity, language and access. Health Serv Res 2003;38:1009–31.

30.

Piehl

Clemens

Joines

JD.

‘Narrowing the gap’: Decreasing emergency department use by children enrolled in the Medicaid program by improving access to primary care. Arch Pediatr Adolesc Med 2000;154:791–5.