Pediatric Primary Care Relationships and Non-Urgent Emergency Department Use in Children

Abstract

Non-urgent emergency department (ED) use contributes to healthcare costs and disrupts continuity of care. Factors influencing patient/guardian decision-making in non-urgent situations are poorly understood. We sought to determine the association of patient/guardian - primary care provider (PCP) relationship with non-urgent ED usage and explore related factors. In an urban practice, we recruited 218 parent-child pairs and administered a survey with the PCP relationship (PDRQ-9), caregiver knowledge of office resources, and care-seeking behavior. We performed a 12-month retrospective chart review to document non-urgent ED visits. We evaluated the association of PDRQ9 and non-urgent ED usage by regression analysis. Mean child age was 7.0 ± 5 years, and 32.6% of children had at least one non-urgent ED visit. Mean PDRQ9 score was 39.8 ± 7.3 and was not associated with non-urgent ED use (P=.46). Lower child age (P < .001) and shorter time coming to the PCP practice (P < .001) were both associated with increased non-urgent ED use. Only 36.4% reported usually going to their PCP when they are sick. Knowledge of office resources was limited, and when prompted with acute, non-urgent medical scenarios, in 4 of 5 scenarios, 50% or more of participants chose to go to the ED over communicating with or going to their PCP. We did not find an association between patient-doctor relationship strength and non-urgent ED usage. Many patients/guardians were unaware of the practice's resources and selected the ED as first choice for acute, non-urgent medical scenarios. Additional work is needed to determine interventions to reduce non-urgent ED use.