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Mahmood AUD, Adily P, Francis S, Eastwood J, Bein K, Chakar BA, Montgomery A. Understanding low acuity emergency department presentations in infancy: A cohort study. Emerg Med Australas 2024; 36:401-412. [PMID: 38239022 DOI: 10.1111/1742-6723.14364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/06/2023] [Accepted: 12/12/2023] [Indexed: 05/21/2024]
Abstract
OBJECTIVE Low acuity presentations (LAPs) contribute to large numbers of ED presentations and carry numerous consequences. The present study sought to improve the understanding of regional infant LAPs by analysing temporal patterns of presentation, discharge diagnoses and potential predictive factors. METHODS This retrospective observational study examined ED presentations among children less than 12 months old (infants) to the Royal Prince Alfred Hospital between 2017 and 2019. Descriptive statistics were used to identify temporal patterns of presentation and common discharge diagnoses among LAPs. Multivariable logistic regression was used to determine the association between early life, demographic and perinatal factors and low acuity presenters. RESULTS Of 6881 infant ED presentations, 19.8% were LAPs, occurring disproportionately on weekdays (82.2%) and during hours of 08.00-17.00 (69.9%). Respiratory tract infections and gastrointestinal complaints were most common overall, though non-allergic rash, feeding difficulties, eczema and developmental concerns contributed substantially among LAPs. Socio-economic status (SES) (odds ratio [OR] 1.71), overseas maternal nationality (OR 1.25) and Medicare ineligible maternal financial class (OR 0.49) were associated with low acuity presenters. Low appearance, pulse, grimace, activity and respiration score (OR 3.53), low SES (OR 3.26), complicated delivery (OR 1.64), maternal multiparity (OR 0.50), maternal partner presence (OR 0.40) and obstetric complications (OR 0.37) were associated with repeat, multi-low acuity presenters (multi-LAPs). CONCLUSION A substantial minority of infant ED presentations are LAPs. Targeted interventions may benefit from focusing on families with a background of socioeconomic disadvantage, social isolation, cultural and linguistic diversity and perinatal complications, with a view to strengthening engagement with community-based services among these groups.
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Affiliation(s)
- Areeb-Ud-Deen Mahmood
- Community Paediatrics, Sydney Local Health District, Sydney, New South Wales, Australia
- UNSW Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Pejman Adily
- Community Paediatrics, Sydney Local Health District, Sydney, New South Wales, Australia
- Ingham Institute of Medical Research, Sydney, New South Wales, Australia
- Database Manager for The Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia
| | - Stephanie Francis
- Royal Prince Alfred Hospital, Emergency Department, Sydney, New South Wales, Australia
- UNSW School of Women's and Children's Health, Sydney, New South Wales, Australia
| | - John Eastwood
- Community Paediatrics, Sydney Local Health District, Sydney, New South Wales, Australia
- Southern District Health Board, South Island, New Zealand
| | - Kendall Bein
- Royal Prince Alfred Hospital, Emergency Department, Sydney, New South Wales, Australia
- RPA Greenlight Institute for Emergency Care, Sydney, New South Wales, Australia
| | - Bashir A Chakar
- Royal Prince Alfred Hospital, Emergency Department, Sydney, New South Wales, Australia
- RPA Greenlight Institute for Emergency Care, Sydney, New South Wales, Australia
| | - Alicia Montgomery
- Community Paediatrics, Sydney Local Health District, Sydney, New South Wales, Australia
- Database Manager for The Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia
- RPA Greenlight Institute for Emergency Care, Sydney, New South Wales, Australia
- UNSW School of Psychiatry, Sydney, New South Wales, Australia
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Lake IV, Lopez CD, Karius AK, Niknahad A, Khoo KH, Girard AO, Yusuf CT, Hopkins E, Lopez J, Redett RJ, Yang R. Treatment Delays in Nonsyndromic Craniosynostosis: A 30-Year Retrospective Case-Control Analysis of the Impact of Socioeconomic and Family Status on Access to Care. Ann Plast Surg 2023; 90:S499-S508. [PMID: 37399479 DOI: 10.1097/sap.0000000000003519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Patients with nonsyndromic craniosynostosis (NSC) generally undergo corrective surgery before 1 year of age to the mitigate morbidities and risks of delayed repair. The cohort of patients who receive primary corrective surgery after 1 year and factors associated with their gaps to care is poorly characterized in literature. METHODS A nested case-control study was conducted for NSC patients who underwent primary corrective surgery at our institution and affiliates between 1992 and 2022. Patients whose surgery occurred after 1 year of age were identified and matched 1:1 by surgical date to standard-care control subjects. Chart review was conducted to gather patient data regarding care timeline and sociodemographic characteristics. RESULTS Odds of surgery after 1 year of age were increased in Black patients (odds ratio, 3.94; P < 0.001) and those insured by Medicaid (2.57, P = 0.018), with single caregivers (4.96, P = 0.002), and from lower-income areas (+1% per $1000 income decrease, P = 0.001). Delays associated with socioeconomic status primarily impacted timely access to a craniofacial provider, whereas caregiver status was associated with subspecialty level delays. These disparities were exacerbated in patients with sagittal and metopic synostosis, respectively. Patients with multisuture synostosis were susceptible to significant delays related to familial strain (foster status, insurer, and English proficiency). CONCLUSIONS Patients from socioeconomically strained households face systemic barriers to accessing optimal NSC care; disparities may be exacerbated by the diagnostic/treatment complexities of specific types of craniosynostosis. Interventions at primary care and craniofacial specialist levels can decrease health care gaps and optimize outcomes for vulnerable patients.
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Affiliation(s)
- Isabel V Lake
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher D Lopez
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alexander K Karius
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ava Niknahad
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kimberly H Khoo
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alisa O Girard
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Cynthia T Yusuf
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth Hopkins
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Richard J Redett
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robin Yang
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Liverpool S, Hayes D, Edbrooke-Childs J. An Affective-Appraisal Approach for Parental Shared Decision Making in Children and Young People's Mental Health Settings: A Qualitative Study. Front Psychiatry 2021; 12:626848. [PMID: 33633610 PMCID: PMC7899973 DOI: 10.3389/fpsyt.2021.626848] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/13/2021] [Indexed: 12/14/2022] Open
Abstract
Background: The majority of existing shared decision making (SDM) models are yet to explicitly account for emotion as an influencing factor to the SDM process. This study aimed to explore the role of parents' and carers' emotional experiences as a concept that has implications for SDM in children and young people's mental health (CYPMH) settings. Methods: A social constructivist grounded theory approach, analyzing data from focus groups (n = 4) and semi-structured interviews (n = 33) with parents and healthcare professionals, was undertaken. Participants were identified and selected at CYPMH sites and through social media platforms or in-person advertising as part of a larger feasibility trial. Interviews and focus groups were audio-recorded and transcribed verbatim. Thematic analysis moved from open to focused coding. Results: The majority of the sample consisted of mothers of adolescent girls. Healthcare professionals had an average of 7.54 (SD = 6.24) years of work experience in CYPMH outpatient capacities. Findings suggested that parents are "expected to, but not always able to" engage in SDM. Themes and subthemes described an affective-appraisal SDM process capturing: (1) views and experiences of SDM, (2) parents' emotional states, (3) the influence of emotions on SDM, and (4) key support systems accessed. The emerging affective-appraisal framework highlighted that negative emotional states hindered parents' active involvement in SDM, and positive emotions encouraged involvement in SDM. Conclusion: The current findings describe an SDM model specific to CYPMH. This new understanding contributes to addressing a possible theory to practice gap opening new challenges and opportunities for academic enquiry.
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Affiliation(s)
- Shaun Liverpool
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, United Kingdom
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Daniel Hayes
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, United Kingdom
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Nicholson E, McDonnell T, De Brún A, Barrett M, Bury G, Collins C, Hensey C, McAuliffe E. Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare - systematic review. BMC Health Serv Res 2020; 20:663. [PMID: 32680518 PMCID: PMC7366445 DOI: 10.1186/s12913-020-05527-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 07/09/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Health systems offer access to unscheduled care through numerous routes; however, it is typically provided by general practitioners (GPs), by emergency medicine doctors in in emergency departments (EDs) and by GPs in out-of-hours GP services such as practitioner cooperatives. Unscheduled healthcare constitutes a substantial portion of healthcare delivery. A systematic review was conducted to establish the factors that influence parents' decision making when seeking unscheduled healthcare for their children. The systematic review question was "What are the factors that influence the decision making of parents and families seeking unscheduled paediatric healthcare?" METHOD Five databases (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and four grey literature databases (Proquest, Lenus, OpenGrey, Google Scholar) were searched. The titles and abstracts of 3746 articles were screened and full-text screening was performed on 177 of these articles. Fifty-six papers were selected for inclusion in the review. Data relating to different types of unscheduled health services (namely primary care, the emergency department and out-of-hours services) were extracted from these articles. A narrative approach was used to synthesise the extracted data. RESULTS Several factors were identified as influencing parental preferences and decision making when seeking unscheduled healthcare for their children. A number of the included studies identified pre-disposing factors such as race, ethnicity and socioeconomic status (SES) as impacting the healthcare-seeking behaviour of parents. Unscheduled healthcare use was often initiated by the parent's perception that the child's condition was urgent and their need for reassurance. The choice of unscheduled service was influenced by a myriad of factors such as: waiting times, availability of GP appointments, location of the ED, and the relationship that the parent or caregiver had with their GP. CONCLUSION Policy and planning initiatives do not always reflect how patients negotiate the health system as a single entity with numerous entry points. Altering patients' behaviour through public health initiatives that seek to improve, for instance, health literacy or reducing emergency hospital admissions through preventative primary care requires an understanding of the relative importance of factors that influence behaviour and decision making, and the interactions between these factors.
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Affiliation(s)
- E. Nicholson
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS) UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - T. McDonnell
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS) UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - A. De Brún
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS) UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - M. Barrett
- Department of Emergency Medicine/National Children’s Research Centre, Children’s Health Ireland at Crumlin, Dublin, Ireland
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - G. Bury
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - C. Collins
- Irish College of General Practitioners, 4/5 Lincoln Place, Dublin 2, Ireland
| | - C. Hensey
- Children’s Health Ireland at Temple St, Temple St, Rotunda, Dublin 1, Ireland
| | - E. McAuliffe
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS) UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
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Godier-McBard LR, Ibbitson L, Hooks C, Fossey M. Military spouses with deployed partners are at greater risk of poor perinatal mental health: a scoping review. J ROY ARMY MED CORPS 2019; 165:363-370. [PMID: 30612103 DOI: 10.1136/jramc-2018-001069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Poor mental health in the perinatal period is associated with a number of adverse outcomes for the individual and the wider family. The unique circumstances in which military spouses/partners live may leave them particularly vulnerable to developing perinatal mental health (PMH) problems. METHODS A scoping review was carried out to review the literature pertaining to PMH in military spouses/partners using the methodology outlined by Arksey and O'Malley (2005). Databases searched included EBSCO, Gale Cengage Academic OneFile, ProQuest and SAGE. RESULTS Thirteen papers fulfilled the inclusion criteria, all from the USA, which looked a PMH or well-being in military spouses. There was a strong focus on spousal deployment as a risk factor for depressive symptoms and psychological stress during the perinatal period. Other risk factors included a lack of social/emotional support and increased family-related stressors. Interventions for pregnant military spouses included those that help them develop internal coping strategies and external social support. CONCLUSIONS US literature suggests that military spouses are particularly at risk of PMH problems during deployment of their serving partner and highlights the protective nature of social support during this time. Further consideration needs to be made to apply the findings to UK military spouses/partners due to differences in the structure and nature of the UK and US military and healthcare models. Further UK research is needed, which would provide military and healthcare providers with an understanding of the needs of this population allowing effective planning and strategies to be commissioned and implemented.
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Affiliation(s)
| | - L Ibbitson
- Veterans and Families Institute, Anglia Ruskin University, Chelmsford, UK
| | - C Hooks
- School of Nursing and Midwifery, Anglia Ruskin University, Chelmsford, UK
| | - M Fossey
- Veterans and Families Institute, Anglia Ruskin University, Chelmsford, UK
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Moth G, Huibers L, Ovesen A, Christensen MB, Vedsted P. Preschool children in out-of-hours primary care - a questionnaire-based cross-sectional study of factors related to the medical relevance of health problems. BMC FAMILY PRACTICE 2017; 18:112. [PMID: 29281986 PMCID: PMC5746005 DOI: 10.1186/s12875-017-0702-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/18/2017] [Indexed: 11/15/2022]
Abstract
Background Out-of-hours primary care (OOH-PC) is intended to provide medical care services for health problems that cannot wait until normal office hours. Children under five years of age represent about 19% of all OOH-PC contacts in Denmark, and the frequency of calls assessed as severe by health professionals is markedly lower for children than for other age groups. Several studies have questioned the appropriateness of the parents’ use of OOH-PC. We aimed to identify factors associated with calls from parents of pre-school children concerning perceived non-severe health problems that were ranked by the triaging GPs as more appropriate for GP office hours (defined as ‘medically irrelevant’). Methods We used data from a cross-sectional study performed in the Central Denmark Region for a 1-year period during 2010–2011. GPs in the OOH-PC assessed random contacts, and a questionnaire was subsequently sent to registered patients. Associations between different factors and the medical irrelevance of contacts were estimated with a generalised linear model to calculate the prevalence ratio (PR). Results Among all included 522 telephone consultations and 1226 face-to-face consultations, we identified 71 (13.6%) telephone consultations and 95 (7.8%) face-to-face consultations that were both assessed as non-severe by the parents and more appropriate for GP office hours by the GPs. For telephone consultations, contacts at other times than 4–8 pm on weekdays were statistically significantly associated with medical irrelevance. Additionally, symptoms of longer duration than 24 h were statistically significantly associated medical irrelevance. Conclusions A large part of the calls to the Danish OOH-PC concern children. The results indicate that some of these calls are made for other than strictly medical reasons. To achieve more effective use of available resources, it might seem relevant to aim at directing more contacts directly to daytime care. However, future studies to enhance our knowledge on parents’ motivation and behaviour would be recommendable.
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Affiliation(s)
- Grete Moth
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark. .,Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark.
| | - Linda Huibers
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark.,Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark
| | - Astrid Ovesen
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark.,Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark.,Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark.,Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark
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