Advice seeking and appropriate use of a pediatric emergency department

Advice seeking and appropriate use of a pediatric emergency department

Oberlander T; Pless IB; Dougherty GE

American Journal Of Diseases Of Children

1993

Child; Cross-Sectional Studies; Female; Humans; infant; Male; Questionnaires; Age Factors; Health Services Research; Severity of Illness Index; Sex Factors; Hospitals; Quebec; Emergency Service; adolescent; Hospital/utilization; Preschool; infant; Newborn; algorithms; Birth Order; Counseling/statistics & numerical data; Health Services Misuse/statistics & numerical data; Parents/education/psychology; Patient Acceptance of Health Care/statistics & numerical data; Pediatric/utilization; Teaching/utilization

OBJECTIVES: To determine whether seeking advice prior to an unscheduled visit to a pediatric emergency department (PED) influences appropriate use of this setting for minor illnesses. DESIGN: Cross-sectional questionnaire survey. SETTING: The medical emergency department of the Montreal (Quebec) Children's Hospital, a major referral and urban teaching hospital. PARTICIPANTS: Four hundred eighty-nine of 562 consecutive parents visiting the PED over two periods, one in February and the other in July 1989. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: Parents of children between 0 and 18 years of age visiting the PED were asked whether they had previously sought advice from family, friends, or a physician. Other factors possibly related to the decision to seek care were also measured. Appropriateness was rated, blind to discharge diagnosis, by two pediatricians using a structured series of questions incorporating the child's age, time of the visit, clinical state, and problem at presentation. Thirty-four percent of visits among respondents were judged appropriate. In bivariate analysis, appropriate visits occurred significantly more often when a parent spoke to both a physician and a nonphysician (47%) prior to visiting the PED than when no advice was sought (29%; P < .05). In multivariate analysis, having a regular physician and being one of two children also contributed to appropriateness. CONCLUSIONS: Appropriate use of the PED was positively influenced by seeking prior advice from both a physician and family member, having a regular physician, and having prior child care experience.

1993

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