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Informing patients on how to access PCP decreased non-urgent ED visits
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Informing patients how to access care from their primary care physician decreased pediatric ED visits for non-urgent care, according to study findings in Clinical Pediatrics.
Jesse J. Sturm, MD, MPH, of Connecticut Children’s Medical Center in West Hartford, Conn., and colleagues conducted a prospective, randomized, controlled study of 332 children admitted to the pediatric ED for non-urgent concerns. Children were aged 3 months to 16 years. Study participants in the intervention group (n=164) received a structured session and handout that outlined office hours and location, scope of practice and preferred steps patients should take to address medical concerns. Study participants in the control group (n=168) received standard care and routine discharge instructions from the pediatric ED nurse. Visitation to the pediatric ED and primary care physician (PCP) were followed over 12 months.
Jesse J. Sturm
At 6-month follow-up, the intervention group reported no change in satisfaction with access to PCP during office hours. However, the percentage of reported ability to obtain advice from a nurse or doctor to help prevent pediatric ED visits increased from 37% to 54% among those who received intervention. Eighty-four percent of intervention patients reported they still had the intervention form and found it helpful. Researchers found no significant difference in non-urgent utilization of the pediatric ED between the intervention and control groups 6 months after enrollment.
At 12 month follow-up, the intervention group had a significantly lower rate of non-urgent pediatric ED utilization compared with controls (44% vs. 53%). Although there was no significant difference in PCP practices for well visits between the two groups, the intervention group experienced a significant increase in the rate of sick visits. The control group had 195 well-child visits compared with 203 visits among the intervention group. During the follow-up period, the control group had 109 sick visits and the intervention group had 139 sick visits.
“These findings underscore that providing patients with advice on how to obtain care in real time is of paramount importance. Since medical decisions to come to the pediatric ED are made within hours of arrival and patients often do not use available telephone resources, having an algorithm at home that provides PCP-specific guidelines on obtaining care in real time seems to address some of these purported barriers to obtaining timely care,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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