The Effect of Prior Interactions With a Primary Care Provider on Nonurgent Pediatric Emergency Department Use

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Abstract
Objective To determine the effect of parental reported difficulty getting care without long waits from a primary care provider (PCP) on nonurgent pediatric emergency department (ED) use. Design Case-control study. Setting Pediatric ED within an urban pediatric hospital. Participants Children, aged 6 months to 12 years, who presented with a chief complaint from a predetermined list of nonurgent (cases) or emergent complaints (controls). Main Outcome Measures Caregivers assessed interactions with a PCP during the previous 12 months by completion of a Consumer Assessment of Health Plans (CAHPS) survey. Baseline demographic variables were compared. Composite CAHPS scores assessing difficulty meeting medical needs, including getting care without long waits, were compared using median tests. Multivariate logistic regression was used to assess the effect of getting care without long waits on nonurgent ED use. Results Of 821 caregivers approached, 719 (87.6%) completed the survey, including 366 cases (50.9%) and 353 controls (49.1%). Those with emergent complaints were older, healthier, and more likely to be male; had higher caregiver education and income levels; and were more likely to have a PCP. Analysis of the CAHPS composite scores revealed increased difficulty meeting medical needs for those with nonurgent complaints, with the greatest difference noted for getting care without long waits (median score, 3.25 vs 3.67;P<.001). In multivariate regression, increased ability to get care without long waits was associated with decreased odds of nonurgent ED use (odds ratio, 0.48; 95% confidence interval, 0.32-0.72). Conclusion Parental-reported previous difficulty getting care without long waits from a PCP is a risk factor for nonurgent ED use.