To evaluate the pattern and reasons for nonurgent use of the pediatric emergency department (PED) during regular office hours and why primary care physicians (PCP) approve such visits.
Prospective, cross-sectional, observational study.
Free-standing, university-affiliated children's hospital emergency department.
Patients presenting to the PED and triaged as nonurgent between June and November 1994, Monday through Friday from 6 : 30 am to 6 : 30 pm, and Saturday 6 : 30 am to 12 : 00 noon.
Registration and triage information and all communication with the PCP.
Of 1020 eligible patients, 364 patients and their PCP completed the study.
Fifty-two percent of the study patients were enrolled in a health maintenance organization (HMO).
This is consistent with the penetration of managed care in this community.
Most HMO (118 of 191,62%) and non-HMO enrollees (147 of 173,86%) did not call their PCP prior to arrival in the PED.
Comparing the reasons given by these patients (HMO enrollees versus non-HMO) for not calling, we found : convenience (HMO 17% vs non-HMO 4%, P<0.01), « no identified PCP » (HMO 17% vs non-HMO 42%, P<0.01), and « felt problem was an emergency » (HMO 19% vs non-HMO 10%, P=0.03) to be important differences.
HMO enrollees received approval for the visit 79% of the time.
These approvals were mostly after noon, whereas most denials occurred before noon.
We found a pattern in the reason for approvals. (...)
Mots-clés Pascal : Service urgence, Pédiatrie, Jour, Utilisation, Service santé, Médecin généraliste, Assurance maladie, Relation médecin malade, Homme, Non urgence, Motif
Mots-clés Pascal anglais : Emergency department, Pediatrics, Day, Use, Health service, General practitioner, Health insurance, Physician patient relation, Human
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0154744
Code Inist : 002B30A05. Création : 21/07/1998.