UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue,AOB - Suite 5400, Pittsburgh, PA, 15224, USA.
Children's Hospital of Los Angeles Medical Group, Los Angeles, USA.
BMC Health Serv Res. 2021 May 17;21(1):466. doi: 10.1186/s12913-021-06480-7.
We aimed to examine how caregiver perceptions of primary care affects care-seeking prior to pediatric non-urgent ED visits.
We performed a cross-sectional survey of caregivers of children presenting to a pediatric ED during weekday business hours and triaged as low acuity. We first compared caregiver sociodemographic characteristics, perceptions of primary care, and stated preference in care sites (ED vs PCP) for caregivers who had sought care from their child's PCP office versus had not sought care from their child's PCP office prior to their ED visit. We then examined odds of having sought care from their PCP office prior to their ED visit using multivariable logistic regression models sequentially including caregiver primary care perceptions and stated care site preferences along with caregiver sociodemographic characteristics.
Of 140 respondents, 64 (46%) sought care from their child's PCP office prior to presenting to the ED. In unadjusted analysis, children insured by Medicaid or CHIP, caregivers identifying as Black, and caregivers with lower educational attainment were less likely to have sought PCP care before presenting to the ED (p < 0.005, each). Caregivers who had sought PCP care were more likely to prefer their PCP relative to the ED in terms of ease of travel, cost, and wait times (p < 0.001, all). When including these stated preferences in a multivariable model, child insurance, caregiver race, and caregiver education were no longer significantly associated with odds of having sought PCP care prior to their ED visit.
Differential access to primary care may underlie observed demographic differences in non-urgent pediatric ED utilization.
本研究旨在探讨初级保健提供者在儿童非紧急情况下就诊前的照护者感知如何影响寻求医疗服务。
我们对在工作日工作时间内到儿科急诊就诊且分诊为低 acuity 的儿童的照护者进行了横断面调查。我们首先比较了在就诊前曾到其儿童的初级保健提供者办公室就诊和未到其儿童的初级保健提供者办公室就诊的照护者的社会人口统计学特征、对初级保健的看法以及对就诊地点（急诊室与初级保健提供者办公室）的选择。然后，我们使用多变量逻辑回归模型，依次包括照护者对初级保健的看法和选择的就诊地点以及照护者的社会人口统计学特征，来检查在就诊前到其儿童的初级保健提供者办公室就诊的可能性。
在 140 名受访者中，有 64 名（46%）在就诊前到其儿童的初级保健提供者办公室就诊。在未调整的分析中，有 Medicaid 或 CHIP 保险的儿童、被认定为黑人的照护者和受教育程度较低的照护者在就诊前到初级保健提供者处就诊的可能性较小（p < 0.005，每项）。在就诊前到初级保健提供者处就诊的照护者更有可能倾向于选择初级保健提供者而不是急诊室，认为在就诊便利性、费用和等待时间方面更有优势（p < 0.001，全部）。当将这些选择偏好纳入多变量模型时，儿童保险、照护者种族和照护者教育与在就诊前到初级保健提供者处就诊的可能性不再显著相关。
初级保健的可及性差异可能是导致非紧急儿科急诊就诊中观察到的人口统计学差异的原因之一。
