Abstract
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.
Highlights
The emergency department (ED) is not always the optimal source of care for children,[1,2] though the challenges and risk factors for repeated ED utilization that children and their caregivers face may be diverse and extensive.[3]
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, trouble finding a doctor (RR = 1.86), scheduling an appointment (RR = 1.68), and transportation access (RR = 1.73)
18% of caregivers reported that their child had visited the ED once, and a still sizeable 16% had ‡2 ED visits in the past 12 months (Table 2)
Summary
The emergency department (ED) is not always the optimal source of care for children,[1,2] though the challenges and risk factors for repeated ED utilization that children and their caregivers face may be diverse and extensive.[3] Considerations identified previously that affect the likelihood of frequent ED visits include whether a child has a chronic condition,[3] younger age of the child,[3,4] as well as socioeconomic status (SES) indicators. The child is less likely to utilize the ED if he or she has private insurance relative to public forms of insurance (eg, Medicaid).[7,8] Inconsistent health coverage may lead to repeated ED utilization as lack of health insurance can result in delayed care, unfilled prescriptions, limited well-child visits, and fractured health care for children.[9,10]
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