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Parents Often Choose ER for Routine Kids' Care
Date:11/24/2008

Wait times, frustration with primary care doctors is driving the trend, study finds

MONDAY, Nov. 24 (HealthDay News) -- Parents who take their kids to the emergency room for non-urgent care aren't doing it to abuse the system.

Instead, they're doing so because they have concerns and questions about the care and attention they receive at primary care physicians' offices.

So finds a new study published in the journal Academic Pediatrics. Often, primary care physicians (PCPs) actually refer patients to a hospital emergency department (ED), the researchers found.

"There were three main reasons parents gave [for taking children to the ED for non-urgent concerns] -- problems with the PCP, referral from the PCP, and advantages of care in the emergency department," said study co-author Dr. Jane M. Brotanek, assistant professor of pediatrics and Robert Wood Johnson Physician Faculty Scholar at the University of Texas Southwestern Medical Center at Dallas.

But there's a price to pay for overloaded emergency departments. "If there's an overwhelming number of ED visits, that can cause problems: longer waits, demands on ED staff, adverse events due to delays in care," Brotanek said.

"It points to the fact that the system needs improvement," she continued. "Reduced ED visits for non-urgent visits may require improvements in PCP office access, efficiency, and health care experiences."

According to background information in the article, use of emergency departments rose 18 percent from 1994 to 2004, with children accounting for 25 percent of those visits (28 million visits per year).

And the majority of pediatric emergency room visits (58 percent to 82 percent) are for "non-urgent" conditions.

Still, no one has really looked at why this is so.

The authors interviewed 31 families of children arriving at a children's hospital emergency department on weekdays (8 a.m. to 4 p.m.) over four weeks. About 95 percent had some form of insurance, and 97 percent had a primary care physician.

"As we spoke to parents, it was clear that there were systems problems," Brotanek said. "They were pointing to various difficulties, saying they were frustrated with long appointment waits at PCP offices, negative attitudes, problems with communication, and there were referrals by the PCP."

"They actually told us that the ED was efficient. They felt like they were able to walk through the ED. It was convenient to them," she continued. "One mom said, 'You don't have to have an appointment, you just come in.' "

Possible solutions could include pediatricians offering same-day appointments for acute problems, longer office hours, better relationships between doctors, patients and families, and better instructions for caring for more routine problems at home.

One study showed that showing parents in advance how to care for ear pain and simple ear infections at home decreased ED visits for these problems by 80 percent.

"I do think that one of the reasons patients choose to come to the ED is due to an inability to access their primary care doctor's office in the time frame that the patient or family would like," said Dr. Robert Femia, chairman of the department of emergency medicine at Lenox Hill Hospital in New York City. "It's not only the health of the child, but also they don't want to take off a day from work, all these other pieces that are part of the puzzle."

Femia added that many hospital emergency rooms are set up to deal with non-urgent care issues.

But this particular study was conducted at a single children's hospital. "There may be some variation in other EDs and other regions of the country and EDs that are not part of a children's hospital," Brotanek said.

Indeed, Dr. Pete Richel, chief of pediatrics at Westchester Hospital in Mt. Kisco, N.Y., said the findings do not corroborate what he sees in his suburban practice. "If that were the case globally, pediatric offices would be closed," he said. "What I find in the suburban setting is that pediatricians have great rapport with families, we seek to become part of the family."

"It's not that I really disagree but, in general, we don't see that," he said. "Here, it is usually not misused because of a lack of confidence or relationship with your primary provider."

More information

There's more on the health of children at the American Academy of Pediatrics.



SOURCES: Jane M. Brotanek, M.D., assistant professor, pediatrics, Robert Wood Johnson Physician Faculty Scholar, University of Texas Southwestern Medical Center at Dallas; Pete Richel, M.D., chief of pediatrics, Westchester Hospital, Mt. Kisco, N.Y.; Robert Femia, M.D., chairman, department of emergency medicine, Lenox Hill Hospital, New York City; Academic Pediatrics


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