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Dowling-Cullen C, Sakellariou D. Decision-making regarding accessing paediatric unscheduled healthcare during the COVID-19 pandemic: a mixed methods rapid review and thematic synthesis. BMJ Open 2024; 14:e085796. [PMID: 39053956 DOI: 10.1136/bmjopen-2024-085796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE Reductions in paediatric unscheduled healthcare utilisation were seen during the COVID-19 pandemic, with concerns around their impact on children's health. The reasons for these changes are not well described. This review aims to explore the factors reported by parents that influenced their decision-making around accessing paediatric unscheduled healthcare during the COVID-19 pandemic. DESIGN Mixed methods rapid review and thematic synthesis based on the Enhancing Transparency of Reporting the Synthesis of Qualitative research framework. DATA SOURCES MEDLINE, Embase, Web of Science, PsycEXTRA, PsycINFO, Global Health, Global Index Medicus, Dissertations and Theses Global, Google Scholar and OAISter. Studies published from January 2020 to July 2023 were included. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Qualitative, quantitative and mixed methods studies that assessed the perspectives of parents on decisions to access or delay or avoid accessing paediatric unscheduled healthcare during the COVID-19 pandemic. DATA EXTRACTION AND SYNTHESIS Nvivo 14.23.0 was used to code results the of the primary studies and develop themes, following a thematic synthesis approach. RESULTS Twelve studies were included, all from high-income settings, mainly in Europe. The studies were conducted across varying times and levels of COVID-19-related restrictions. The principal descriptive themes identified were (i) concerns about COVID-19 infection, (ii) balancing and navigating risks, (iii) perception of healthcare service status and conditions and (iv) perception of information and advice. These were developed into analytic themes to further describe the decision-making process. CONCLUSIONS Parents balanced a range of risks, concerns, advice and responsibilities when considering accessing paediatric unscheduled healthcare during the COVID-19 pandemic. External sources of advice and information were important; misconceptions around public health advice may reflect the multitude of information sources and the rapidly changing circumstances of the pandemic. Public health policy and planning should consider parent perspectives when developing measures to ensure equitable access to appropriate paediatric healthcare services.
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Hall B, Tegge A, Cotache Condor C, Rhoads M, Wattsman TA, Witcher A, Creamer E, Tupetz A, Smith ER, Reddy Tokala M, Meier B, Rice HE. Understanding family-level decision-making when seeking access to acute surgical care for children: Protocol for a cross-sectional mixed methods study. PLoS One 2024; 19:e0304165. [PMID: 38913675 PMCID: PMC11195935 DOI: 10.1371/journal.pone.0304165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 05/03/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND There is limited understanding of how social determinants of health (SDOH) impact family decision-making when seeking surgical care for children. Our objectives of this study are to identify key family experiences that contribute to decision-making when accessing surgical care for children, to confirm if family experiences impact delays in care, and to describe differences in family experiences across populations (race, ethnicity, socioeconomic status, rurality). METHODS We will use a prospective, cross-sectional, mixed methods design to examine family experiences during access to care for children with appendicitis. Participants will include 242 parents of consecutive children (0-17 years) with acute appendicitis over a 15-month period at two academic health systems in North Carolina and Virginia. We will collect demographic and clinical data. Parents will be administered the Adult Responses to Children's Symptoms survey (ARCS), the child and parental forms of the Adverse Childhood Experiences (ACE) survey, the Accountable Health Communities Health-Related Social Needs Screening Tool, and Single Item Literacy Screener. Parallel ARCS data will be collected from child participants (8-17 years). We will use nested concurrent, purposive sampling to select a subset of families for semi-structured interviews. Qualitative data will be analyzed using thematic analysis and integrated with quantitative data to identify emerging themes that inform a conceptual model of family-level decision-making during access to surgical care. Multivariate linear regression will be used to determine association between the appendicitis perforation rate and ARCS responses (primary outcome). Secondary outcomes include comparison of health literacy, ACEs, and SDOH, clinical outcomes, and family experiences across populations. DISCUSSION We expect to identify key family experiences when accessing care for appendicitis which may impact outcomes and differ across populations. Increased understanding of how SDOH and family experiences influence family decision-making may inform novel strategies to mitigate surgical disparities in children.
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Affiliation(s)
- Bria Hall
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States of America
| | - Allison Tegge
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States of America
| | - Cesia Cotache Condor
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, NC, United States of America
| | - Marie Rhoads
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States of America
| | - Terri-Ann Wattsman
- Department of Surgery, Carilion Clinic, Roanoke, VA, United States of America
| | - Angelica Witcher
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States of America
| | - Elizabeth Creamer
- School of Education, Virginia Tech University, Blacksburg, VA, United States of America
| | - Anna Tupetz
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Emily R. Smith
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, NC, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Mamata Reddy Tokala
- Health Analytics Research Team, Carilion Clinic, Roanoke, VA, United States of America
| | - Brian Meier
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States of America
- Department of Emergency Medicine, Carilion Clinic, Roanoke, VA, United States of America
| | - Henry E. Rice
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, NC, United States of America
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Lin C, Tu P, Parker T, Mella-Velazquez A, Bier B, Braund WE. The Influences of SES on Patient Choice of Doctor: A Systematic Review. Am J Prev Med 2024:S0749-3797(24)00210-1. [PMID: 38906427 DOI: 10.1016/j.amepre.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION As patients become increasingly involved in healthcare decision-making, it is important to examine the drivers behind patient choice of doctor (PCOD); the initial decision can have lasting impacts on patients' trust in providers and health outcomes. However, limited studies have explored PCOD relative to socioeconomic status (SES) or health disparity. This review identified similar preferences and varied decision criteria in PCOD across SES groups. METHODS PubMed, PsycINFO, Web of Science, and relevant cross-references were searched for articles published between January 2007-September 2022. Papers were screened using Covidence. Included studies examined PCOD by income and/or educational levels. Analysis was performed in 2022-2023. RESULTS From 4,449 search results, 29 articles were selected (16 countries, 14 medical specialties, total of 32,651 participants). Individuals of higher SES ranked physician characteristics (e.g., qualifications, empathy) or performance more important than cost or convenience. Individuals of lower SES often had to prioritize logistical factors (e.g., insurance coverage, distance) due to resource constraints and gaps in knowledge or awareness about options. Despite differing healthcare systems, such divergence in PCOD were relatively consistent across countries. Some patients, especially females and disadvantaged groups, favored gender-concordant physicians for intimate medical matters (e.g., gynecologist); this partiality was not limited to conservative cultures. Few researchers investigated the outcomes of PCOD and indicated that lower-SES populations inadvertently chose, experienced, or perceived lower quality of care. DISCUSSION Patients' decision criteria varied by SES, even under national systems intended for universal access, indicating the impacts of social determinants and structural inequities. Health education supporting patient decision-making and research on how SES affects PCOD and outcomes could help reduce health disparity.
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Affiliation(s)
- Cheryl Lin
- Policy and Organizational Management Program, Duke University, Durham, North Carolina
| | - Pikuei Tu
- Policy and Organizational Management Program, Duke University, Durham, North Carolina.
| | - Taylor Parker
- Policy and Organizational Management Program, Duke University, Durham, North Carolina
| | | | - Brooke Bier
- Policy and Organizational Management Program, Duke University, Durham, North Carolina
| | - Wendy E Braund
- Pennsylvania Department of Health, Harrisburg, Pennsylvania
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McTaggart J, Beeden E, Farooq A. Lost in research: children, healthcare and epistemic injustice. Arch Dis Child 2024; 109:433-435. [PMID: 37400230 DOI: 10.1136/archdischild-2023-325745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Affiliation(s)
- James McTaggart
- Educational Psychology Service, Highland Council, Inverness, UK
- School of Humanities, Social Sciences and Law, University of Dundee, Dundee, UK
| | - Emma Beeden
- Patient Liaison Group, British Medical Association, London, UK
| | - Aishah Farooq
- Children and Young People's Transformation Programme, NHS England and NHS Improvement London, London, UK
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Ziemnik L, Parker N, Bufi K, Waters K, Almeda J, Stolfi A. Low-Acuity Pediatric Emergency Department Utilization: Caregiver Motivations. Pediatr Emerg Care 2024:00006565-990000000-00421. [PMID: 38534003 DOI: 10.1097/pec.0000000000003195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVES Proper emergency department (ED) utilization is a hallmark of population health. Emergency department overcrowding due to nonurgent visits causes increased stress to healthcare staff, higher costs, and longer wait times for more urgent cases. This study sought to better understand post pandemic reasons caregivers have when bringing in their children for nonurgent visits and devise effective interventions to improve caregiver choice for non-ED care for nonurgent conditions. METHODS Surveys were conducted at an urban pediatric hospital for Emergency Severity Index (ESI) level 3 to 5 visits. A total of 602 surveys were completed with 8 being excluded from analysis. Survey responses and anonymized demographic information were collected. Responses were compared between surveys grouped by respondent age category, relation to child, child's race, insurance type, and ESI levels. RESULTS Primary reasons given for nonurgent ED visits were perceived urgency (74.2%, n = 441), ED superiority to other locations (23.9%, n = 142), and referral to the ED by a third party (17.7%, n = 105). Of those who cited perceived urgency as a reason, 80.5% (n = 355) wanted to lessen their child's pain/discomfort as soon as possible, but only 13.6% said that their child was too ill to be seen anywhere else (n = 60). Demographic differences occurred in the proportions of respondents citing some of the primary and secondary reasons for bringing their child to the ED. CONCLUSIONS This study highlights 3 key findings. An immediate desire for care plays a key role in caregiver decision making for low-acuity visits. There is potential socioeconomic and racial bias in where care is recommended that needs to be further explored in this region. Cross community interventions that target key reasons for seeking low-acuity care have the highest likelihood of impacting the use of the ED for low-acuity conditions.
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Volerman A, Carlson B, Wan W, Murugesan M, Asfour N, Bolton J, Chin MH, Sripipatana A, Nocon RS. Utilization, quality, and spending for pediatric Medicaid enrollees with primary care in health centers vs non-health centers. BMC Pediatr 2024; 24:100. [PMID: 38331758 PMCID: PMC10851548 DOI: 10.1186/s12887-024-04547-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Limited research has explored the performance of health centers (HCs) compared to other primary care settings among children in the United States. We evaluated utilization, quality, and expenditures for pediatric Medicaid enrollees receiving care in HCs versus non-HCs. METHODS This national cross-sectional study utilized 2012 Medicaid Analytic eXtract (MAX) claims to examine children 0-17 years with a primary care visit, stratified by whether majority (> 50%) of primary care visits were at HCs or non-HCs. Outcome measures include utilization (primary care visits, non-primary care outpatient visits, prescription claims, Emergency Department (ED) visits, hospitalizations) and quality (well-child visits, avoidable ED visits, avoidable hospitalizations). For children enrolled in fee-for-service Medicaid, we also measured expenditures. Propensity score-based overlap weighting was used to balance covariates. RESULTS A total of 2,383,270 Medicaid-enrolled children received the majority of their primary care at HCs, while 18,540,743 did at non-HCs. In adjusted analyses, HC patients had 20% more primary care visits, 15% less non-primary care outpatient visits, and 21% less prescription claims than non-HC patients. ED visits were similar across the two groups, while HC patients had 7% lower chance of hospitalization than non-HC. Quality of care outcomes favored HC patients in main analyses, but results were less robust when excluding managed care beneficiaries. Total expenditures among the fee-for-service subpopulation were lower by $239 (8%) for HC patients. CONCLUSIONS In this study of nationwide claims data to evaluate healthcare utilization, quality, and spending among Medicaid-enrolled children who receive primary care at HCs versus non-HCs, findings suggest primary care delivery in HCs may be associated with a more cost-effective model of healthcare for children.
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Affiliation(s)
- Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
| | - Bradley Carlson
- University of Chicago Pritzker School of Medicine, 924 E 57th St, Chicago, IL, 60637, USA
| | - Wen Wan
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Manoradhan Murugesan
- Department of Public Health Sciences, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Nour Asfour
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Joshua Bolton
- Health Resources and Services Administration (Affiliation at Time Research Conducted), 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Marshall H Chin
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Alek Sripipatana
- Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Robert S Nocon
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S Los Robles Ave, Pasadena, CA, 91101, USA
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Jaboyedoff M, Starvaggi C, Suris JC, Kuehni CE, Gehri M, Keitel K. Drivers for low-acuity pediatric emergency department visits in two tertiary hospitals in Switzerland: a cross-sectional, questionnaire-based study. BMC Health Serv Res 2024; 24:103. [PMID: 38238764 PMCID: PMC10797974 DOI: 10.1186/s12913-023-10348-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 11/18/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE Low-acuity pediatric emergency department (PED) visits are frequent in high-income countries and have a negative impact on patient care at the individual and health system levels. Knowing what drives low-acuity PED visits is crucial to inform adaptations in health care delivery. We aimed to identify factors associated with low-acuity PED visits in Switzerland, including socioeconomic status, demographic features, and medical resources of families. METHODS We conducted a prospective, questionnaire-based study in the PEDs of two Swiss tertiary care hospitals, Bern and Lausanne. We invited all consecutive children and their caregiver attending the PED during data collection times representative of the overall PED consultation structure (e.g. day/night, weekdays/weekends) to complete a questionnaire on demographic features, socioeconomic status, and medical resources. We collected medical and administrative data about the visit and defined low-acuity visits as those meeting all of the following criteria: (1) triage category 4 or 5 on the Australasian Triage Scale, (2) no imaging or laboratory test performed, and (3) discharge home. We used a binary multiple logistic regression model to identify factors associated with low-acuity visits. RESULTS We analysed 778 PED visits (September 2019 to July 2020). Most children visiting our PEDs had a designated primary care provider (92%), with only 6% not having seen them during the last year. Fifty-five per cent of caregivers had asked for medical advice before coming to the PED. The proportion of low-acuity visits was 58%. Low-acuity visits were associated with caregiver's difficulties paying bills (aOR 2.6, 95% CI 1.6 - 4.4), having already visited a PED in the last 6 months (aOR 1.7, 95% CI 1.1 - 2.5) but not with parental education status, nor parental country of birth, parental employment status or absence of family network. CONCLUSION Economic precariousness is an important driver for low-acuity PED visits in Switzerland, a high-income country with compulsory health coverage where most children have a designated primary care provider and a regular pediatric follow-up. Primary care providers and PEDs should screen families for economic precariousness and offer anticipatory guidance and connect those in financial need to social support.
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Affiliation(s)
- Manon Jaboyedoff
- Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Carl Starvaggi
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joan-Carles Suris
- Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Mario Gehri
- Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kristina Keitel
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Burns SK, Krishnamurti T, Doan TT, Hanmer J, Hoberman A, Kahn JM, Schweiberger K, Ray KN. Parent Perceptions of Telemedicine for Acute Pediatric Respiratory Tract Infections: Sequential Mixed Methods Study. JMIR Pediatr Parent 2024; 7:e49170. [PMID: 38227360 PMCID: PMC10828946 DOI: 10.2196/49170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/01/2023] [Accepted: 12/13/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Since 2020, parents have had increasing opportunities to use telemedicine for their children, but how parents decide whether to use telemedicine for acute pediatric care relative to alternative sites of care is not clear. One of the most common reasons parents seek acute care for their children is for acute respiratory tract infections (ARTIs). OBJECTIVE This study aims to examine parental expectations of care via telemedicine for pediatric ARTIs, contrasting expectations of care delivered via primary care telemedicine and direct-to-consumer (DTC) telemedicine. METHODS We performed a sequential mixed methods analysis to examine how parents assess telemedicine for their children's acute care. We used ARTIs as a case study for examining parent perceptions of telemedicine. First, we analyzed semistructured interviews focused on parent responses about the use of telemedicine. Each factor discussed by parents was coded to reflect whether parents indicated it incentivized or disincentivized their preferences for telemedicine versus in-person care. Results were organized by a 7-dimension framework of parental health care seeking that was generated previously, which included dimensions related to care sites (expected access, affordability, clinical quality, and site quality) and dimensions related to child or family factors (perceived illness severity, perceived child susceptibility, and parent self-efficacy). Second, we analyzed responses to a national survey, which inquired about parental expectations of primary care telemedicine, commercial DTC telemedicine, and 3 in-person sites of care (primary care, urgent care, and emergency department) across 21 factors identified through prior qualitative work. To assess whether parents had different expectations of different telemedicine models, we compared survey responses for primary care telemedicine and commercial DTC telemedicine using weighted logistic regression. RESULTS Interview participants (n=40) described factors affecting their perceptions of telemedicine as a care modality for pediatric ARTIs. Generally, factors aligned with access and affordability (eg, decreased wait time and lower out-of-pocket cost) were discussed as potential incentives for telemedicine use, while factors aligned with perceived illness severity, child susceptibility, and clinician quality (eg, trustworthiness) were discussed as potential disincentives for telemedicine use. In survey responses (n=1206), primary care and commercial DTC telemedicine were rated similarly on items related to expected accessibility and affordability. In contrast, on items related to expected quality of care, primary care telemedicine was viewed similarly to in-person primary care, while commercial DTC telemedicine was rated lower. For example, 69.7% (weighted; 842/1197) of respondents anticipated their children would be comfortable and cooperative with primary care telemedicine versus 49.7% (weighted; 584/1193) with commercial DTC telemedicine (P<.001). CONCLUSIONS In a mixed methods analysis focused on telemedicine for ARTIs, parents expressed more concerns about telemedicine quality in commercial DTC models compared with primary care-based telemedicine. These results could help health systems better design telemedicine initiatives to support family-centered care.
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Affiliation(s)
- Sarah K Burns
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Tamar Krishnamurti
- Department of Medicine, University Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Tran T Doan
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Janel Hanmer
- Department of Medicine, University Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Alejandro Hoberman
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Jeremy M Kahn
- Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Kelsey Schweiberger
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Kristin N Ray
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Jawad D, Wen LM, Rissel C, Baur L, Mihrshahi S, Taki S. Barriers and enablers to accessing child health resources and services: Findings from qualitative interviews with Arabic and Mongolian immigrant mothers in Australia. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241242674. [PMID: 38561970 PMCID: PMC10989050 DOI: 10.1177/17455057241242674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/10/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Over the past two decades, there has been an increase of immigrants in Australia. Despite this, the availability of culturally responsive resources and services that cater to their needs remains insufficient. OBJECTIVE The aim of this study was to explore the resources used and trusted by Mongolian- and Arabic-speaking migrant mothers in Australia for child health information and examine how they navigate and overcome challenges they encounter accessing this information. DESIGN Semi-structured telephone interview. METHODS A theory informed semi-structured 60-min telephone interview was conducted in Arabic and Mongolian with 20 Arabic- and 20 Mongolian-speaking migrant mothers of children younger than 2 years or currently pregnant and living in Australia. Data were analysed thematically using the framework method. RESULTS The reliance on digital platforms such as google emerged as a common trend among both groups of mothers when seeking child health information. Notably, there were differences in resources selection, with Mongolian mothers showing a preference for Australian-based websites, while Arabic-speaking mothers tended to opt for culturally familiar resources. There were various barriers that hindered their access to health services and resources, including language barriers, cost, and limited knowledge or familiarity with their existence. Negative encounters with healthcare professionals contributed to a perception among many mothers that they were unhelpful. Both groups of mothers employed a cross-checking approach across multiple websites to verify trustworthiness of information. Acculturation was shown only among the Mongolian-speaking mothers who adapted their cultural practices in line with their country of residence. CONCLUSION The findings of this study highlight the importance of addressing the needs of migrant mothers in accessing child health information. Health professionals, government agencies, and researchers have an opportunity to provide culturally responsive support by fostering a culturally inclusive approach to developing and promoting equitable access to services and resources, ultimately enhancing the wellbeing of migrant families.
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Affiliation(s)
- Danielle Jawad
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, NSW, Australia
- Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), The University of Sydney, Camperdown, NSW, Australia
| | - Li Ming Wen
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, NSW, Australia
- Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), The University of Sydney, Camperdown, NSW, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, NSW Health, Camperdown, NSW, Australia
| | - Chris Rissel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- College of Medicine and Public Health, Rural and Remote Health SA and NT, Flinders University, Darwin, Bedford Park, SA, Australia
| | - Louise Baur
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), The University of Sydney, Camperdown, NSW, Australia
- Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Sarah Taki
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, NSW, Australia
- Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), The University of Sydney, Camperdown, NSW, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, NSW Health, Camperdown, NSW, Australia
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Gosselin S, Vincent M. To be in ED or not to be: a parent's dilemma. CAN J EMERG MED 2024; 26:3-4. [PMID: 38194061 DOI: 10.1007/s43678-023-00634-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Affiliation(s)
- Sophie Gosselin
- Emergency Department CISSS Montérégie-Centre, Hôpital Charles LeMoyne, Greenfield Park, Quebec, Canada.
- Family Medicine and Emergency Medicine Department, FMSSS Université de Sherbrooke, Sherbrooke, Quebec, Canada.
| | - Matthieu Vincent
- Emergency Department CISSS Montérégie-Centre, Hôpital Charles LeMoyne, Greenfield Park, Quebec, Canada
- Family Medicine and Emergency Medicine Department, FMSSS Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Emergency Department, CHU Ste-Justine, Montreal, Quebec, Canada
- Department of Paediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Samman K, Le CK, Burstein B, Rehimini S, Grenier A, Bertrand-Bureau C, Mallet M, Simonyan D, Berthelot S. Parents' perspective on pediatric emergency department visits for low-acuity conditions before and during the COVID-19 pandemic: a cross-sectional bicentric study. CAN J EMERG MED 2024; 26:31-39. [PMID: 38032525 DOI: 10.1007/s43678-023-00609-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES The primary objective of this study was to describe and compare the motivation of parents/guardians to bring children with low-acuity conditions to a tertiary-care pediatric emergency department (ED) versus a clinic before and after the pandemic. The secondary objectives were to describe and compare the demographic and clinical characteristics of the population studied and the impact of the pandemic on their access to primary care services. METHODS This is a cross-sectional study based on a survey administered to parents/guardians of patients presenting with low-acuity conditions at one of two EDs. RESULTS The respondents numbered 659. Children were brought to a pediatric ED generally because of the perceived urgency of the condition, the presumed resource availability in the pediatric ED and the unavailability of the primary care physician. However, most respondents (n = 438, 66.5%) indicated preference for a clinic. More respondents before than during the pandemic reported they had been unable to find a doctor outside the ED (48.6% before COVID vs 26.8% during COVID, p < 0.001) but patients during the pandemic were less likely to seek care in a primary care practice or walk-in clinic (30.0% during COVID vs 48.6% before COVID, p < 0.001). In addition, the number of respondents presenting with symptoms of infection decreased by more than half after the pandemic began while the proportion of musculoskeletal and psychiatric complaints doubled. CONCLUSION Although the pandemic has altered the landscape of presenting complaints and pediatric healthcare-seeking behaviors, most respondents indicated they would prefer to receive care in a clinic. This finding contradicts the view that most pediatric ED visits for low-acuity conditions are by choice rather than perceived necessity. Prioritizing improved access to primary care resources would better address the preferences and expectations of parents/guardians.
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Affiliation(s)
- Karol Samman
- Department of Pediatrics, Centre Hospitalier Régional de Lanaudière, St-Charles-Borromée, QC, Canada
| | - Cathie-Kim Le
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montréal, QC, Canada
| | - Brett Burstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montréal, QC, Canada
- Department of Biostatistics, Epidemiology and Occupational Health, McGill University, Montréal, QC, Canada
| | | | - Anthony Grenier
- Department of Family Medicine, GMF Nouvelle-Beauce, Sainte-Marie, QC, Canada
| | | | - Myriam Mallet
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Simon Berthelot
- Département de médecine de famille et de médecine d'urgence, Université Laval, Québec, QC, Canada.
- Centre de recherche du CHU de Québec-Université Laval, Axe Santé des populations et pratiques optimales en santé,, Québec, QC, Canada.
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Terry D, Peck B, Kloot K. Paediatric Emergency Asthma Presentations: Temporal Trends and Representations in Rural Australia. Healthcare (Basel) 2023; 11:3113. [PMID: 38132002 PMCID: PMC10742987 DOI: 10.3390/healthcare11243113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Asthma is a key illness driving children to present to emergency departments, and although paediatric emergency asthma presentations have been examined, the temporal trends remain somewhat elusive. The aim is to highlight, describe, and model the temporal trends of emergency paediatric asthma presentations, using comprehensive hospital emergency presentation data. A retrospective cross-sectional study examined de-identified paediatric (0 to 14 years) emergency asthma presentation data over a three-year period. Data were obtained from nine healthcare facilities in Victoria, Australia. Episode-level data were collected through RAHDaR, a comprehensive emergency data register which includes missing data (35.0%) among rural health facilities not currently captured elsewhere. Monthly presentation rates demonstrate a significant difference in presentations between fall/autumn and spring, and males had higher presentation rates in February and June-August. Emergency presentations were more likely to occur Sunday-Tuesday, peaking in the time periods of 8-9 a.m., 11 a.m.-12 p.m., and 8-9 p.m. Significant differences were noted between all age groups. Examining previously unavailable rural data has highlighted patterns among emergency asthma presentations for children 0-14 years of age. Knowledge of these by season, month, and day of the week, in combination with time of day, offers scope for more focused workforce education and planning, and nuanced referral pathways, particularly in resource-limited settings.
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Affiliation(s)
- Daniel Terry
- School of Nursing and Midwifery, University of Southern Queensland, Ipswich, QLD 4305, Australia;
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC 3350, Australia;
| | - Blake Peck
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC 3350, Australia;
| | - Kate Kloot
- School of Medicine, Deakin University, Warrnambool, VIC 3280, Australia
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13
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Nicholson E, McDonnell T, Conlon C, De Brún A, Doherty E, McAuliffe E. Parent's preferences for unscheduled paediatric healthcare: A discrete choice experiment. Health Expect 2023; 26:1931-1940. [PMID: 37338038 PMCID: PMC10485340 DOI: 10.1111/hex.13802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/03/2023] [Accepted: 06/10/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Unscheduled healthcare is a key component of healthcare delivery and makes up a significant proportion of healthcare access, with children being particularly high users of unscheduled healthcare. Understanding the relative importance of factors that influence this behaviour and decision-making is fundamental to ensuring the system is best designed to meet the needs of users and foster appropriate cost-effective usage of health system resources. OBJECTIVE The aim of the study was to identify the parent's preferences for unscheduled healthcare for a common mild childhood illness. DESIGN A discrete choice experiment (DCE) was developed to identify the preferences of parents accessing unscheduled healthcare for their children. SETTING AND PARTICIPANTS Data were collected from parents in Ireland (N = 458) to elicit preferences across five attributes: timeliness, appointment type, healthcare professional attended, telephone guidance before attending and cost. RESULTS Using a random parameters logit model, all attributes were statistically significant, cost (β = -5.064, 95% confidence interval, CI [-5.60, -4.53]), same-day (β = 1.386, 95% CI [1.19, 1.58]) or next-day access (β = 0.857, 95% CI [0.73, 0.98]), coupled with care by their own general practitioner (β = 0.748, 95% CI [0.61, 0.89]), identified as the strongest preferences of parents accessing unscheduled healthcare for their children. DISCUSSION The results have implications for policy development and implementation initiatives that seek to improve unscheduled health services as understanding how parents use these services can maximise their effectiveness. PATIENT OR PUBLIC CONTRIBUTION The development of the DCE included a qualitative research component to ensure that the content accurately reflected parents experiences when seeking healthcare. Before data collection, a pilot test was carried out with the target population to gather their views on the survey.
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Affiliation(s)
- Emma Nicholson
- School of PsychologyDublin City UniversityDublin 9Ireland
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery and Health SystemsUCD College of Health and Agricultural SciencesDublinIreland
| | - Thérèse McDonnell
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery and Health SystemsUCD College of Health and Agricultural SciencesDublinIreland
| | - Ciara Conlon
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery and Health SystemsUCD College of Health and Agricultural SciencesDublinIreland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery and Health SystemsUCD College of Health and Agricultural SciencesDublinIreland
| | - Edel Doherty
- J.E. Cairnes School of Business & EconomicsNational University of Ireland GalwayGalwayIreland
| | - Eilish McAuliffe
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery and Health SystemsUCD College of Health and Agricultural SciencesDublinIreland
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14
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King E, Dick S, Hoddinott P, Malcolm C, France E, Kyle RG, Aucott L, Wilson P, Turner S. Regional variations in short stay urgent paediatric hospital admissions: a sequential mixed-methods approach exploring differences through data linkage and qualitative interviews. BMJ Open 2023; 13:e072734. [PMID: 37748848 PMCID: PMC10533722 DOI: 10.1136/bmjopen-2023-072734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/23/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES The aim of this sequential mixed-methods study was to describe and understand how paediatric short stay admission (SSA) rates vary across Health Board regions of Scotland. DESIGN Exploratory sequential mixed-methods study. Routinely acquired data for the annual (per capita) SSA to hospital were compared across the 11 regions. Five diverse regions with different SSA per capita formed cases for qualitative interviews with health professionals and parents to explore how care pathways, service features and geography may influence decisions to admit. SETTING Scotland. PARTICIPANTS All children admitted to hospital 2015-2017. Healthcare staff (n=48) and parents (n=15) were interviewed. RESULTS Of 171 039 urgent hospital admissions, 92 229 were SSAs, with a fivefold variation between 14 and 69/1000 children/year across regions. SSAs were higher for children in the most deprived compared with the least deprived communities. When expressed as a ratio of highest to lowest SSA/1000 children/year for diagnosed conditions between regions, the ratio was highest (10.1) for upper respiratory tract infection and lowest (2.8) for convulsions. Readmissions varied between 0.80 and 2.52/1000/year, with regions reporting higher SSA rates more likely to report higher readmission rates (r=0.70, p=0.016, n=11). Proximity and ease of access to services, local differences in service structure and configuration, national policy directives and disparities in how an SSA is defined were recognised by interviewees as explaining the observed regional variations in SSAs. Socioeconomic deprivation was seldom spontaneously raised by professionals when reflecting on reasons to refer or admit a child. Instead, greater emphasis was placed on the wider social circumstances and parents' capacity to cope with and manage their child's illness at home. CONCLUSION SSA rates for children vary quantitatively by region, condition and area deprivation and our interviews identify reasons for this. These findings can usefully inform future care pathway interventions.
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Affiliation(s)
- Emma King
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Smita Dick
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - Pat Hoddinott
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Cari Malcolm
- School of Health Science, University of Dundee, Dundee, UK
| | - Emma France
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | | | - Lorna Aucott
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Philip Wilson
- Institute of Health and Wellbeing, University of Aberdeen, Aberdeen, UK
| | - Stephen Turner
- Department of Child Health, University of Aberdeen, Aberdeen, UK
- Division of Women and Children, NHS Grampian, Aberdeen, UK
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15
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Alotaibi MA, Alhowimel AS, Alodaibi FA, Aloraifi M. The Practice of Shared Decision-Making Among Physiotherapists and Patients with Musculoskeletal Conditions. J Multidiscip Healthc 2023; 16:2655-2665. [PMID: 37706183 PMCID: PMC10496844 DOI: 10.2147/jmdh.s425315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
Purpose Shared decision-making (SDM) may be interpreted as a set of core values rather than as a consensus definition. This study aimed to explore how SDM between patients and physiotherapists may lead to patient satisfaction. Patients and Methods A cross-sectional study was conducted to examine the relationship between SDM and patient satisfaction. The study targeted physiotherapists and patients with musculoskeletal pain or disorders. A structured questionnaire (the nine-item Shared Decision-Making Questionnaire) was developed to show the extent to which patients felt involved in the process by scoring nine items from 0 to 5 on a six-point scale. t-tests were performed to estimate differences in SDM perceptions between patients and physiotherapists, and regression analyses were performed to estimate the best predictors of SDM. Results The questionnaire was completed by a total of 106 patients and nine physiotherapists. The demographic information of the samples was presented with frequency analysis. This study's findings demonstrate no variations in the final SDM perceptions between patients and physiotherapists, but when SDM was contrasted step-by-step (as items), many variances were discovered. These distinctions reinforce the notion that regardless of the end outcome, the process of reaching a consensus has a distinct profile depending on the type of medical care. Therapists emphasize the first steps, possibly because there is sufficient evidence to make a therapeutic decision. However, patients highlight the final steps, perhaps because the moment for a decision based on the consultation's nature is approaching. Conclusion This study demonstrates that SDM is a complex process that must be examined in multiple stages. However, in physiotherapy contexts, this process exhibits extremely different patterns, reflecting a significantly different perspective of the decision-making process.
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Affiliation(s)
- Mazyad A Alotaibi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ahmed S Alhowimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Faris A Alodaibi
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Aloraifi
- Salamat Medical Hospital, Department of Physiotherapy, Hail, Saudi Arabia
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16
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Gren C, Hasselager AB, Linderoth G, Frederiksen MS, Folke F, Ersbøll AK, Gamst-Jensen H, Cortes D. Video triage in calls concerning children with fever at an out-of-hours medical helpline: a prospective quality improvement study. Scand J Trauma Resusc Emerg Med 2023; 31:41. [PMID: 37644510 PMCID: PMC10464404 DOI: 10.1186/s13049-023-01106-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Parents often contact out-of-hours services due to worry concerning febrile children, despite the children rarely being severely ill. As telephone triage of children is challenging, many children are referred to hospital assessment. This study investigated if video triage resulted in more children staying at home. Secondary aims included safety, acceptability and feasibility of this new triage tool. METHODS In this prospective quality improvement study, nurse call-handlers enrolled febrile children aged 3 months-5 years to video or telephone triage (1:1), with follow-up within 48 h after call. The setting was an out-of-hours call-center for non-urgent illness in Copenhagen, Denmark, receiving over 1 million calls annually and predominately staffed by registered nurses. Main outcome measure was difference in number of children assessed at hospital within 8 h after call between video-and telephone triage group. Rates of feasibility, acceptability and safety (death, lasting means, transfer to intensive care unit) were compared between the triage groups. RESULTS There was no difference in triage outcome (home care vs. hospital referral) or number of patients assessed at hospital between triage groups. However, more video triaged patients received in-hospital treatment, testing and hospitalization. CONCLUSION Video triage was feasible to conduct, acceptable to parents and as safe as telephone triage. The study did not show that more children stayed at home after video triage, possibly because the allocation strategy was not upheld, as video triage sometimes was chosen in cases of complex and severe symptoms, and this likely has changed study outcome. TRIAL REGISTRATION Clinicaltrials.gov.: Id NCT04074239. Registered 2019-08-30. https://clinicaltrials.gov/ct2/show/study/NCT04074239.
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Affiliation(s)
- Caroline Gren
- Department of Pediatrics and Adolescence Medicine, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Asbjoern Boerch Hasselager
- Department of Pediatrics and Adolescence Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Gitte Linderoth
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Anesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Copenhagen University Hospital - Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Marianne Sjølin Frederiksen
- Department of Pediatrics and Adolescence Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen University Hospital - Copenhagen Emergency Medical Services, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- Copenhagen University Hospital - Copenhagen Emergency Medical Services, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Hejdi Gamst-Jensen
- Department of Anesthesia, Center of Head and Orthopedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Dina Cortes
- Department of Pediatrics and Adolescence Medicine, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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17
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Quek SE, Seow C, Ganapathy S. Caregiver experiences in an Asian paediatric emergency department during the COVID-19 pandemic. Singapore Med J 2023:384041. [PMID: 37675668 DOI: 10.4103/singaporemedj.smj-2021-394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
- Samuel Enci Quek
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
| | - Christopher Seow
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Sashikumar Ganapathy
- Department of Emergency Medicine, KK Women's and Children's Hospital; Duke-NUS Medical School, Singapore
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18
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Vukovic AA, Krentz C, Gauthier A, Harun N, Porter SC. The Association of Emergency Severity Index Score and Patient and Family Experience in a Pediatric Emergency Department. J Patient Exp 2023; 10:23743735231179040. [PMID: 37469553 PMCID: PMC10353023 DOI: 10.1177/23743735231179040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
The study aim was to determine the relationship between a patient's Emergency Severity Index (ESI) score and their or their family's response to the key performance indicator (KPI) question on the post-visit patient and family experience (PFE) survey. Retrospective review of patients presenting to the Pediatric Emergency Department between July 1, 2021, and June 30, 2022, who completed the KPI question on an associated post-visit survey. We performed univariate analyses on all candidate variables; multivariable linear regression identified independent predictors of KPI on the PFE survey. A total of 8136 patients were included in the study. Although ESI score was significantly associated with PFE in univariate analysis, this association was lost in the multivariable model. Independent associations were appreciated with race/ethnicity, time to provider, length of stay, and procedure performance during the visit. Although ESI is not independently associated with PFE in this study, its interaction with factors such as time to provider, length of stay, and procedure performance may be important for emergency department providers creating interventions to impact experience during low acuity visits.
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Affiliation(s)
- Adam A Vukovic
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Callie Krentz
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Abigail Gauthier
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nusrat Harun
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stephen C Porter
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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19
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Davis E, Fagnano M, Halterman JS, Frey SM. Utilization of the emergency department as a routine source of care among children with asthma. J Asthma 2023; 60:1377-1385. [PMID: 36399630 PMCID: PMC10192056 DOI: 10.1080/02770903.2022.2149409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/28/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
Objective: To describe characteristics of children with persistent asthma in the ED who receive most of their healthcare in emergency settings; and determine whether recent asthma experiences or historic patterns of care are associated with identifying the ED as a typical location for care.Methods: We conducted a sub-analysis of baseline data from Telemedicine Enhanced Asthma Management through the Emergency Department (TEAM-ED), an RCT of children (3-12 years) presenting to the ED with persistent asthma (2016-2020). Caregivers identified reasons for seeking emergency care, including if their child received most overall healthcare in the ED ('ED Care'; primary outcome) or not ('Other Care'). Independent variables included demographics, recent symptoms and quality of life (QOL), and historic preventive care and healthcare use. We compared responses between ED Care and Other Care groups using bivariate and multivariate analyses.Results: We analyzed data for 355 children (31% ED Care, 69% Other Care). Compared with Other Care, ED Care respondents were more likely to identify the ED as the closest source of healthcare; report fewer symptom nights but a poorer quality of life; and describe the ED as a usual place for sick care, despite most having a PCP.Conclusions: Many children with asthma use the ED as a typical source of healthcare, and are distinguished by need for proximity, poorer caregiver QOL, and historic patterns of care-seeking. Efforts to improve timely access to outpatient care and reinforce the role of PCP-directed asthma management, such as through telemedicine, may reduce preventable morbidity including ED visits.
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Affiliation(s)
- Erin Davis
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Maria Fagnano
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Jill S. Halterman
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sean M. Frey
- University of Rochester School of Medicine and Dentistry, Rochester, NY
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20
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Breckons M, Thorne S, Walsh R, Bhopal S, Owens S, Rankin J. Parental perspectives on emergency health service use during the first wave of the COVID-19 pandemic in the United Kingdom: A qualitative study. PLoS One 2023; 18:e0285375. [PMID: 37256845 PMCID: PMC10231793 DOI: 10.1371/journal.pone.0285375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 04/23/2023] [Indexed: 06/02/2023] Open
Abstract
UK 'Lockdown' measures introduced in March 2020 aimed to mitigate the spread of COVID-19. Although seeking healthcare was still permitted within restrictions, paediatric emergency department attendances reduced dramatically and led to concern over risks caused by delayed presentation. Our aim was to gain insight into healthcare decisions faced by parents during the first wave of the COVID-19 pandemic and to understand if use of urgent healthcare, self-care, and information needs differed during lockdown as well as how parents perceived risks of COVID-19. We undertook qualitative telephone interviews with a purposive sample of parents living in the North East of England recruited through online advertising. We used a semi-structured interview schedule to explore past and current healthcare use, perceptions of risk and the impact of the pandemic on healthcare decisions. Interviews were transcribed and analysed using Thematic Analysis. Three major themes were identified which concerned (i) how parents made sense of risks posed to, and by their children, (ii) understanding information regarding health services and (iii) attempting to make the right decision. These themes contribute to the understanding of the initial impact of COVID-19 and associated restrictions on parental decisions about urgent healthcare for children. These findings are important to consider when planning for potential future public health emergencies but also in the wider context of encouraging appropriate use of urgent healthcare.
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Affiliation(s)
- Matthew Breckons
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration North East & North Cumbria, Newcastle-upon-Tyne, United Kingdom
| | - Sophie Thorne
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Rebecca Walsh
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sunil Bhopal
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration North East & North Cumbria, Newcastle-upon-Tyne, United Kingdom
- Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Stephen Owens
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration North East & North Cumbria, Newcastle-upon-Tyne, United Kingdom
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21
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Simoens E, Michiels L, Toelen J, de Winter P. Navigating the unknown: understanding and managing parental anxiety when a child is ill. Arch Dis Child 2023:archdischild-2022-325220. [PMID: 36927621 DOI: 10.1136/archdischild-2022-325220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/07/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Parents are often confronted with a difficult decision when their child falls ill: should they go to the general practitioner (GP) or not? This study aims to describe this process comprehensively in order to allow clinicians to assess the extent to which parents can recognise clinical warning signs and act accordingly. The purpose of this study is to describe parents' decision-making processes when deciding whether or not to consult a GP for their sick child. METHODS We used a qualitative study design based on semistructured interviews to investigate the decision-making process of 25 parents. Four case scenarios describing a developing illness in a child were presented. RESULTS Parents' reasons for seeking medical attention could be divided into two main categories. First, non-specific fears lead parents to consult a doctor. Parents were alarmed by the persistence and progression of symptoms, the combination of symptoms or changes in their child's behaviour or they needed reassurance. Second, several specific fears were identified. Sometimes, parents fear a specific disease, while at other times, they are concerned about warning signs. Some parents, however, would not seek medical attention at any decision point even though their child could be in a potentially life-threatening situation. CONCLUSIONS Although parents make carefully considered decisions on whether or not to consult a doctor, many appear to miss red flags, including more experienced parents. Conversely, some become overly concerned with certain specific symptoms such as fever, and few parents are familiar with self-management strategies.
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Affiliation(s)
- Elise Simoens
- Department of Pediatrics, KU Leuven University Hospitals, Leuven, Belgium
| | - Lauren Michiels
- Department of Pediatrics, KU Leuven University Hospitals, Leuven, Belgium
| | - Jaan Toelen
- Department of Pediatrics, KU Leuven University Hospitals, Leuven, Belgium.,Leuven Child and Health Institute, KU Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Peter de Winter
- Leuven Child and Health Institute, KU Leuven, Leuven, Belgium .,Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands
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22
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Sapp C, McCreery R, Holte L, Oleson J, Walker E. Descriptions of Hearing Loss Severity Differentially Influence Parental Concern about the Impact of Childhood Hearing Loss. Ear Hear 2023; 44:287-299. [PMID: 36314965 PMCID: PMC10810141 DOI: 10.1097/aud.0000000000001280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
PURPOSE The purpose of this study was to measure how parent concern about childhood hearing loss varies under different description conditions: classification-based, audibility-based, and simulation-based descriptions. METHOD We randomly allocated study participants (n = 143) to complete an online survey about expected child difficulties with listening situations with hearing loss. Our participants were parents of children with typical hearing in the 0- to 12-month age range. Participants were exposed to one type of description (classification-based, audibility-based, or simulation-based) and one level of hearing loss (slight, mild, and moderate or their audibility and simulation equivalents), producing nine total groups. Participants rated the level of expected difficulty their child would experience performing age-appropriate listening tasks with the given hearing loss. They also selected what they perceived as the most appropriate intervention from a list of increasingly intense options. RESULTS Our findings revealed that audibility-based descriptions elicited significantly higher levels of parent concerns about hearing loss than classification-based strategies, but that simulation-based descriptions elicited the highest levels of concern. Those assigned to simulation-based and audibility-based groups also judged relatively more intense intervention options as appropriate compared to those assigned to classification-based groups. CONCLUSIONS This study expands our knowledge base about descriptive factors that impact levels of parent concern about hearing loss after diagnosis. This has potentially cascading effects on later intervention actions such as fitting hearing technology. It also provides a foundation for developing and testing clinical applications of audibility-based counseling strategies.
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Affiliation(s)
- Caitlin Sapp
- Department of Pediatric Audiology, University of North Carolina Medical Center, Chapel Hill, NC
| | | | - Lenore Holte
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA
| | - Jacob Oleson
- Department of Biostatistics, University of Iowa, Iowa City, IA
| | - Elizabeth Walker
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA
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23
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Dick S, MacRae C, McFaul C, Wilson P, Turner SW. Interventions in primary and community care to reduce urgent paediatric hospital admissions: systematic review. Arch Dis Child 2023; 108:486-491. [PMID: 36804396 DOI: 10.1136/archdischild-2022-324986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/08/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND There has been a rise in urgent paediatric hospital admissions and interventions to address this are required. OBJECTIVE To systemically review the literature describing community (or non-hospital)-based interventions designed to reduce emergency department (ED) visits or urgent hospital admissions. DATA SOURCES MEDLINE, Embase, OVIS SP, PsycINFO, Science Citation Index Expanded/ISI Web of Science (1981-present), the Cochrane Library database and the Database of Abstracts of Reviews of Effectiveness. STUDY ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) and before-and-after studies. PARTICIPANTS Individuals aged <16 years. STUDY APPRAISAL AND SYNTHESIS METHODS Papers were independently reviewed by two researchers. Data extraction and the Critical Appraisals Skills Programme checklist was completed (for risk of bias assessment). RESULTS Seven studies were identified. Three studies were RCTs, three were a comparison between non-randomised groups and one was a before-and-after study. Interventions were reconfiguration of staff roles (two papers), telemedicine (three papers), pathways of urgent care (one paper) and point-of-care testing (one paper). Reconfiguration of staff roles resulted in reduction in ED visits in one study (with a commensurate increase in general practitioner visits) but increased hospital admissions from ED in a second. Telemedicine was associated with a reduction in children's admissions in one study and reduced ED admissions in two further studies. Interventions with pathways of care and point-of-care testing did not impact either ED visits or urgent admissions. CONCLUSIONS AND IMPLICATIONS New out-of-hospital models of urgent care for children need to be introduced and evaluated without delay. PROSPERO REGISTRATION NUMBER CRD42021274374.
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Affiliation(s)
- Smita Dick
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - Clare MacRae
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Claire McFaul
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - Philip Wilson
- Institute of Health and Wellbeing, University of Aberdeen, Aberdeen, UK
| | - Stephen W Turner
- Department of Child Health, University of Aberdeen, Aberdeen, UK
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Hatachi T, Hashizume T, Taniguchi M, Inata Y, Aoki Y, Kawamura A, Takeuchi M. Machine Learning-Based Prediction of Hospital Admission Among Children in an Emergency Care Center. Pediatr Emerg Care 2023; 39:80-86. [PMID: 36719388 DOI: 10.1097/pec.0000000000002648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Machine learning-based prediction of hospital admissions may have the potential to optimize patient disposition and improve clinical outcomes by minimizing both undertriage and overtriage in crowded emergency care. We developed and validated the predictive abilities of machine learning-based predictions of hospital admissions in a pediatric emergency care center. METHODS A prognostic study was performed using retrospectively collected data of children younger than 16 years who visited a single pediatric emergency care center in Osaka, Japan, between August 1, 2016, and October 15, 2019. Generally, the center treated walk-in children and did not treat trauma injuries. The main outcome was hospital admission as determined by the physician. The 83 potential predictors available at presentation were selected from the following categories: demographic characteristics, triage level, physiological parameters, and symptoms. To identify predictive abilities for hospital admission, maximize the area under the precision-recall curve, and address imbalanced outcome classes, we developed the following models for the preperiod training cohort (67% of the samples) and also used them in the 1-year postperiod validation cohort (33% of the samples): (1) logistic regression, (2) support vector machine, (3) random forest, and (4) extreme gradient boosting. RESULTS Among 88,283 children who were enrolled, the median age was 3.9 years, with 47,931 (54.3%) boys and 1985 (2.2%) requiring hospital admission. Among the models, extreme gradient boosting achieved the highest predictive abilities (eg, area under the precision-recall curve, 0.26; 95% confidence interval, 0.25-0.27; area under the receiver operating characteristic curve, 0.86; 95% confidence interval, 0.84-0.88; sensitivity, 0.77; and specificity, 0.82). With an optimal threshold, the positive and negative likelihood ratios were 4.22, and 0.28, respectively. CONCLUSIONS Machine learning-based prediction of hospital admissions may support physicians' decision-making for hospital admissions. However, further improvements are required before implementing these models in real clinical settings.
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Affiliation(s)
- Takeshi Hatachi
- From the Department of Intensive Care Medicine, Osaka Women's and Children's Hospital
| | - Takao Hashizume
- Department of Pediatrics, SAKAI Children's Emergency Medical Center, Osaka
| | - Masashi Taniguchi
- From the Department of Intensive Care Medicine, Osaka Women's and Children's Hospital
| | - Yu Inata
- From the Department of Intensive Care Medicine, Osaka Women's and Children's Hospital
| | | | - Atsushi Kawamura
- From the Department of Intensive Care Medicine, Osaka Women's and Children's Hospital
| | - Muneyuki Takeuchi
- From the Department of Intensive Care Medicine, Osaka Women's and Children's Hospital
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25
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Malcolm C, King E, France E, Kyle RG, Kumar S, Dick S, Wilson P, Aucott L, Turner SW, Hoddinott P. Short stay hospital admissions for an acutely unwell child: A qualitative study of outcomes that matter to parents and professionals. PLoS One 2022; 17:e0278777. [PMID: 36525432 PMCID: PMC9757586 DOI: 10.1371/journal.pone.0278777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Numbers of urgent short stay admissions (SSAs) of children to UK hospitals are rising rapidly. This paper reports on experiences of SSAs from the perspective of parents accessing urgent care for their acutely unwell child and of health professionals referring, caring for, or admitting children. METHODS A qualitative interview study was conducted by a multi-disciplinary team with patient and public involvement (PPI) to explore contextual factors relating to SSAs and better understand pre-hospital urgent care pathways. Purposive sampling of Health Board areas in Scotland, health professionals with experience of paediatric urgent care pathways and parents with experience of a SSA for their acutely unwell child was undertaken to ensure maximal variation in characteristics such as deprivation, urban-rural and hospital structure. Interviews took place between Dec 2019 and Mar 2021 and thematic framework analysis was applied. RESULTS Twenty-one parents and forty-eight health professionals were interviewed. In the context of an urgent SSA, the themes were centred around shared outcomes of care that matter. The main outcome which was common to both parents and health professionals was the importance of preserving the child's safety. Additional shared outcomes by parents and health professionals were a desire to reduce worries and uncertainty about the illness trajectory, and provide reassurance with sufficient time, space and personnel to undertake a period of skilled observation to assess and manage the acutely unwell child. Parents wanted easy access to urgent care and, preferably, with input from paediatric-trained staff. Healthcare professionals considered that it was important to reduce the number of children admitted to hospital where safe and appropriate to do so. CONCLUSIONS The shared outcomes of care between parents and health professionals emphasises the potential merit of adopting a partnership approach in identifying, developing and testing interventions to improve the acceptability, safety, efficiency, and cost-effectiveness of urgent care pathways between home and hospital.
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Affiliation(s)
- Cari Malcolm
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
- * E-mail: (PH); (CM)
| | - Emma King
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
| | - Emma France
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
| | - Richard G. Kyle
- Academy of Nursing, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Simita Kumar
- Screening and Immunisation, Public Health Scotland, Edinburgh, United Kingdom
| | - Smita Dick
- Child Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Philip Wilson
- Centre for Rural Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Lorna Aucott
- Centre for Randomised Healthcare Trials, University of Aberdeen, Aberdeen, United Kingdom
| | - Stephen W. Turner
- Child Health, University of Aberdeen, Aberdeen, United Kingdom
- NHS Grampian, Aberdeen, United Kingdom
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
- * E-mail: (PH); (CM)
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Scott J, Khanom A, Straw J, Strickland A, Porter A, Snooks H. Paediatric frequent use of emergency medical services: a systematic review. Emerg Med J 2022; 40:emermed-2021-211701. [PMID: 36600465 DOI: 10.1136/emermed-2021-211701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Frequent use of emergency medical services (EMS) is recognised to be a global phenomenon, although paediatric frequent use is poorly understood. This systematic review aimed to understand how paediatric frequent use of EMS is currently defined, identify factors associated with paediatric frequent use of EMS and determine effectiveness of interventions for paediatric patients who frequently use EMS. METHODS Four electronic databases (Medline, CINAHL, Web of Science and PsycINFO) were searched to September 2022 for primary, peer-reviewed research studies published in English from January 2000. Studies were included that examined frequent use (>1 contact during study period) of EMS or other services with arrival via EMS. Paediatric patients were defined as <18 years of age or otherwise defined by study authors as paediatric/adolescent/children. Data were extracted using a structured proforma, and quality was assessed using the Standard Quality Assessment Criteria for Quantitative Studies but did not influence inclusion decisions. Data were presented using narrative synthesis. RESULTS The search resulted in 4172 unique references, with 12 papers included in the review from 7 countries. Four were EMS studies, and eight Emergency Department with arrival via EMS. All studies used retrospective designs, with no interventional studies identified. Paediatric frequent EMS users were more likely to use services for medical reasons rather than trauma, including respiratory complaints, mental health and seizures, but data on gender and ethnicity were inconclusive and silent on socioeconomic status. There was no consistency in definitions of either a paediatric patient or of frequent use. CONCLUSION The broad range of reasons for frequent use suggests that a single intervention is unlikely to be effective at addressing the causes of frequent use. There is a need for further research to better identify the underlying reasons for frequent EMS use among paediatric patients and to develop interventions in this population.
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Affiliation(s)
- Jason Scott
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | | | - Joanne Straw
- Emergency Operations Centre, Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Annette Strickland
- Emergency Operations Centre, Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Alison Porter
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Helen Snooks
- Swansea University Medical School, Swansea University, Swansea, UK
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27
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Gren C, Pedersen MK, Hasselager AB, Folke F, Ersbøll AK, Cortes D, Egerod I, Gamst-Jensen H. How parents express their worry in calls to a medical helpline: a mixed methods study. BMC PRIMARY CARE 2022; 23:80. [PMID: 35421930 PMCID: PMC9012025 DOI: 10.1186/s12875-022-01680-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/24/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Telephone triage is used globally in out-of-hours primary care, to prioritize who needs urgent assessment. Even though children rarely are severely ill, calls about sick children are among the most prevalent, mainly due to parental worry. Pediatric calls are considered challenging, as the call-handler must rely on parents’ second-hand information. We aimed to investigate if parents’ worry can be used as a predictor of severe illness, and if the content of the calls varies between different grades of worry.
Methods
In a convergent mixed methods study design we asked patients to rate their degree-of-worry before talking to a call-handler. We used quantitative data of degree-of-worry, triage- and patient outcome in pediatric calls (n = 2857), and the qualitative content from 54 calls with subsequent hospitalization ≥24 h.
Results
High degree-of-worry was associated with hospitalization ≥24 h (OR 3.33, 95% CI 1.53–7.21). Qualitative findings both confirmed and expanded knowledge of degree-of-worry. Worry was the predominant cause for contact overall, and was mainly triggered by loss-of-control. In calls with high degree-of-worry, the prevalence of loss-of-control was especially high, and the parents had additionally often contacted healthcare services recently. Parents with a foreign accent often rated their worry as high, and these callers were often ignored or interrupted. Calls with low degree-of-worry seemed to occur early during the disease.
Conclusion
High degree of parental worry was associated with severe illness. At the end of calls, call-handlers should ensure that the parent has regained control of the situation to reach increased reassurance and to prevent renewed unnecessary contact. Safety-netting is crucial, as many parents made contact early during the illness and deterioration may develop later. The scoring of parental degree-of-worry may be used as an indicator of potentially severe illness and can easily be implemented at out-of-hours call-centers globally.
Trial registration
Original study registered at clinicaltrials.gov (NCT02979457).
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28
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Appleby G, Papageorgiou V, Horter S, Wharton-Smith A, Sajjanhar T, Hemeson A, Singogo E, Cahill B, Keers S, Wicksey L, Emedo M, Yim A, Nyirenda-Nyang’wa M. Caregiver perceptions and experiences of paediatric emergency department attendance during the COVID-19 pandemic: A mixed-methods study. PLoS One 2022; 17:e0276055. [PMID: 36383622 PMCID: PMC9668109 DOI: 10.1371/journal.pone.0276055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background During the early stages of the COVID-19 pandemic, concerns were raised about reduced attendance at hospitals, particularly in paediatric emergency departments, which could result in preventable poorer outcomes and late presentations among children requiring emergency care. We aimed to investigate the impact of COVID-19 on health-seeking behaviour and decision-making processes of caregivers presenting to paediatric emergency services at a National Health Service (NHS) Trust in London. Materials and methods We conducted a mixed-methods study (survey and semi-structured interviews) across two hospital sites between November-December 2020. Data from each study were collected concurrently followed by data comparison. Results Overall, 100 caregivers participated in our study; 80 completed the survey only, two completed the interview only and 18 completed both. Our quantitative study found that almost two-thirds (63%, n = 62) of caregivers attended the department within two days of their child becoming ill. Our qualitative study identified three major themes which were underpinned by concepts of trust, safety and uncertainty and were assessed in relation to the temporal nature of the pandemic and the caregivers’ journey to care. We found most caregivers balanced their concerns of COVID-19 and a perceived “overwhelmed” NHS by speaking to trusted sources, predominantly general practitioners (GPs). Conclusion Caregivers have adapted their health-seeking behaviour throughout the pandemic as new information and guidance have been released. We identified several factors affecting decisions to attend; some existed before the pandemic (e.g., concerns for child’s health) whilst others were due to the pandemic (e.g., perceived risks of transmission when accessing healthcare services). We recommend trusted medical professionals, particularly GPs, continue to provide reassurance to caregivers to seek emergency paediatric care when required. Communicating the hospital safety procedures and the importance of early intervention to caregivers could additionally provide reassurance to those concerned about the risks of accessing the hospital environment.
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Affiliation(s)
- Gayle Appleby
- Lewisham and Greenwich NHS Trust, London, United Kingdom
| | | | - Shona Horter
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Tina Sajjanhar
- Lewisham and Greenwich NHS Trust, London, United Kingdom
| | | | | | | | - Sophie Keers
- Lewisham and Greenwich NHS Trust, London, United Kingdom
| | | | - Marylyn Emedo
- Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Alastair Yim
- Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Maggie Nyirenda-Nyang’wa
- Lewisham and Greenwich NHS Trust, London, United Kingdom
- The Infection, Immunity and Inflammation Research and Teaching Department, University College London, London, United Kingdom
- * E-mail:
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29
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Yousef HA, Abdel Wahab MM, Alsheikh S, Alghamdi R, Alghamdi R, Alkanaan N, Al-Qahtani M, Albuali WH, Almakhaita H, Aldossari M, Yousef AA. Characteristics of Pediatric Primary Healthcare Visits in a University-Based Primary Healthcare Center in Saudi Arabia. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1743. [PMID: 36421192 PMCID: PMC9688705 DOI: 10.3390/children9111743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 10/03/2023]
Abstract
This study aimed to identify the characteristics of pediatric primary health care (PHC) visits and evaluate the outcomes of patients presenting with complaints along with their referral and consultation capabilities. This was a retrospective medical record-based study. The study population included any pediatric patient (≤14 years old), including females and males, Saudis, and non-Saudis. Research data were gathered for visits from 2016-2021. Sampling was performed using a stratified random sample based on age groups, followed by simple random sampling with proportional allocation to different age groups. The number of pediatric visits included was 1439 (males, 52.2%). The most common age group was toddlers, and 60% of the total sample was from Saudi Arabia. The most common cause of visits was vaccination (32%), followed by general checkups and/or a well-baby visit (25.4%), and fever (11.2%). Approximately 10% of visits needed referral to other subspecialties. Approximately 50% of visits with complaints concerning ophthalmology, cardiology, and surgical intervention were referred to a specialized department. More awareness needs to be raised about the important role of PHC services in the pediatric age group, as it was capable of handling approximately 90% of their cases.
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Affiliation(s)
- Haneen A. Yousef
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Moataza M. Abdel Wahab
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Shahad Alsheikh
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Rizam Alghamdi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Raghad Alghamdi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Najla Alkanaan
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Mohammad Al-Qahtani
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Department of Paediatrics, King Fahd Hospital of the University, Shura Street, Al Aqrabiyah, Al Khobar 34445, Saudi Arabia
| | - Waleed H. Albuali
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Department of Paediatrics, King Fahd Hospital of the University, Shura Street, Al Aqrabiyah, Al Khobar 34445, Saudi Arabia
| | - Huda Almakhaita
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Mae Aldossari
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Abdullah A. Yousef
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Department of Paediatrics, King Fahd Hospital of the University, Shura Street, Al Aqrabiyah, Al Khobar 34445, Saudi Arabia
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30
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Wells JM, Rodean J, Cook L, Sills MR, Neuman MI, Kornblith AE, Jain S, Hirsch AW, Goyal MK, Fleegler EW, DeLaroche AM, Aronson PL, Leonard JC. Injury-Related Pediatric Emergency Department Visits in the First Year of COVID-19. Pediatrics 2022; 150:188520. [PMID: 35836331 DOI: 10.1542/peds.2021-054545] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe the epidemiology of pediatric injury-related visits to children's hospital emergency departments (EDs) in the United States during early and later periods of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. METHODS We conducted a cross-sectional study using the Pediatric Health Information System, an administrative database to identify injury-related ED visits at 41 United States children's hospitals during the SARS-CoV-2 pandemic period (March 15, 2020 to March 14, 2021) and a 3 year comparator period (March 15-March 14, 2017-2020). For these 2 periods, we compared patient characteristics, injury type and severity, primary discharge diagnoses, and disposition, stratified by early (March 15, 2020 to June 30, 2020), middle (July 1, 2020 to October 31, 2020), and late (November 1, 2020 to March 14, 2021) pandemic periods. RESULTS Overall, ED injury-related visits decreased by 26.6% during the first year of the SARS-CoV-2 pandemic, with the largest decline observed in minor injuries. ED injury-related visits resulting in serious-critical injuries increased across the pandemic (15.9% early, 4.9% middle, 20.6% late). Injury patterns with the sharpest relative declines included superficial injuries (41.7% early) and sprains/strains (62.4% early). Mechanisms of injury with the greatest relative increases included (1) firearms (22.9% early; 42.8% middle; 37% late), (2) pedal cyclists (60.4%; 24.9%; 32.2%), (3) other transportation (20.8%; 25.3%; 17.9%), and (4) suffocation/asphyxiation (21.4%; 20.2%; 28.4%) and injuries because of suicide intent (-16.2%, 19.9%, 21.8%). CONCLUSIONS Pediatric injury-related ED visits declined in general. However, there was a relative increase in injuries with the highest severity, which warrants further investigation.
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Affiliation(s)
- Jordee M Wells
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | | | - Lawrence Cook
- Department of Pediatrics, School of Medicine, The University of Utah, Salt Lake City, Utah
| | - Marion R Sills
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Mark I Neuman
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aaron E Kornblith
- Departments of Emergency Medicine and Pediatrics, University of California San Francisco, San Francisco, California
| | - Shobhit Jain
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Mercy Hospital, Kansas City, Missouri
| | - Alexander W Hirsch
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Monika K Goyal
- Department of Pediatrics, Children's National Hospital, The George Washington University, Washington, District of Columbia
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amy M DeLaroche
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Paul L Aronson
- Departments of Pediatrics and of Emergency Medicine, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Julie C Leonard
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
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31
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Wells JM, Galarneau JM, Minich NM, Cohen DM, Clinton K, Taylor HG, Bigler ED, Bacevice A, Mihalov LK, Bangert BA, Zumberge NA, Yeates KO. Social determinants of participant recruitment and retention in a prospective cohort study of pediatric mild traumatic brain injury. Front Neurol 2022; 13:961024. [PMID: 36176559 PMCID: PMC9513452 DOI: 10.3389/fneur.2022.961024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPrior studies have shown poor recruitment and retention of minoritized groups in clinical trials.ObjectiveTo examine several social determinants as predictors of consent to participate and retention as part of a prospective, longitudinal cohort study of children 8–16 with either mild traumatic brain injury (mild TBI) or orthopedic injury (OI).MethodsChildren and families were recruited during acute visits to emergency departments (ED) in two large children's hospitals in the midwestern United States for a prospective, longitudinal cohort study of children 8–16 with either mild TBI or OI.ResultsA total of 588 (mild TBI = 307; OI = 281) eligible children were approached in the ED and 315 (mild TBI = 195; OI = 120) were consented. Children who consented did not differ significantly from those who did not consent in sex or age. Consent rates were higher among Black (60.9%) and multi-racial (76.3%) children than white (45.3%) children. Among the 315 children who consented, 217 returned for a post-acute assessment (mild TBI = 143; OI = 74), a retention rate of 68.9%. Participants who were multi-racial (96.6%) or white (79.8%) were more likely to return for the post-acute visit than those who were Black (54.3%).ConclusionsRacial differences exist in both recruitment and retention of participants in a prospective, longitudinal cohort of children with mild TBI or OI. Further work is needed to understand these differences to ensure equitable participation of minoritized groups in brain injury research.
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Affiliation(s)
- Jordee M. Wells
- Department of Pediatrics, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States
- *Correspondence: Jordee M. Wells
| | - Jean-Michel Galarneau
- Department of Psychology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Nori M. Minich
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, United States
| | - Daniel M. Cohen
- Department of Pediatrics, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States
| | - Kameron Clinton
- Department of Pediatrics, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States
| | - H. Gerry Taylor
- Department of Pediatrics, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States
| | - Erin D. Bigler
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT, United States
| | - Ann Bacevice
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, United States
| | - Leslie K. Mihalov
- Department of Pediatrics, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States
| | - Barbara A. Bangert
- Departments of Radiology and Neurosurgery, University Hospitals Health System, Cleveland, OH, United States
| | - Nicholas A. Zumberge
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Visscher S, van Stralen K, Toelen J, de Winter P. Parental and physician disagreement on help-seeking in paediatric case scenarios. Arch Dis Child 2022; 107:833-838. [PMID: 35351739 DOI: 10.1136/archdischild-2021-323504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/04/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Whenever a child falls ill, parents need to decide whether there is a need to contact medical professionals. Parental and physician perspectives on the severity of a child's illness differ. We aimed to determine triggers for help-seeking among parents. DESIGN AND SETTING We conducted a survey study among 200 parents. In four hypothetical case scenarios, an acutely ill child was described with a baseline symptom (abdominal pain, rhinitis, headache, limping), with deterioration over time. Parents had to answer when they would contact the general practitioner. Fifty-four physicians received the same case scenarios. MAIN OUTCOME MEASURES Parents and physicians did not differ significantly in help-seeking in the abdominal pain case. In the non-urgent rhinitis case, parents sought help earlier than physicians wished them to, while in the urgent illness cases of headache and limping parents tend to seek help later than physicians wished. Rising body temperature was more alarming to parents than physicians, while loss of appetite did not concern either group. Parents did not recognise several red flags, for example, drowsiness and refusal to stand. Low educated parents and parents with a history of more frequent healthcare use were inclined to seek help earlier. IMPLICATION OF RESULTS In urgent cases, parents do not seem to recognise red flags, while some non-urgent symptoms trigger them to seek help. This reveals a need for mutual education. Physician awareness of a perception gap could help them adjust their communication and empower parents.
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Affiliation(s)
- Sarah Visscher
- Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands
| | - Karlijn van Stralen
- Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands
| | - Jaan Toelen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Leuven Child and Youth Institute, KU Leuven, Leuven, Belgium.,Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Peter de Winter
- Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands .,Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Leuven Child and Youth Institute, KU Leuven, Leuven, Belgium
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Wyatt S, Aldridge P, Ross S, Narayanan S, Zuccolo L. The Frequency of Infant-Feeding Presentations at English Emergency Departments During the SARS-CoV-2 Pandemic: A Nation-Wide Electronic Health Records Study. Cureus 2022; 14:e27645. [PMID: 36072185 PMCID: PMC9439262 DOI: 10.7759/cureus.27645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 11/05/2022] Open
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Nicholson E, Doherty E, Guerin S, Schreiber J, Barrett M, McAuliffe E. Healthcare utilisation and unmet health needs in children with intellectual disability: a propensity score matching approach using longitudinal cohort data. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:442-453. [PMID: 35285998 PMCID: PMC9310956 DOI: 10.1111/jir.12927] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 01/25/2022] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Health disparities for children with intellectual disabilities can be challenging to measure due to many other factors that can impact health and healthcare use. The aim of the current study was to use longitudinal cohort data to compare children with intellectual disability (ID) in Ireland between 2006 and 2014 on healthcare utilisation and unmet need, at ages 9 and 13, using a propensity score matching (PSM) approach. METHODS Using data from the Growing up in Ireland study, PSM was used to identify an appropriate control sample to compare with a sample of children with ID (n = 124). Participants were matched on variables that are known to influence healthcare utilisation to reduce the impact of confounding variables between groups so that differences between the groups can be estimated. Logistic regression was used to estimate effects at ages 9 and 13. RESULTS Children with ID were no more likely to have visited a general practitioner or emergency department in the past 12 months than children without ID. They did have a greater likelihood of visiting a doctor in a hospital in the past 12 months and of having an overnight stay in hospital by age 9. Primary caregivers of children with ID were more likely to report unmet health needs at ages 9 and 13. CONCLUSIONS This approach is a novel means of comparing healthcare use in this population by balancing the impact of other factors that may result in inequities, to which children with ID may be more vulnerable.
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Affiliation(s)
- E. Nicholson
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS)UCD School of Nursing, Midwifery and Health Systems, UCD College of Health and Agricultural SciencesDublinIreland
- School of Psychology, Faculty of Science and HealthDublin City UniversityGlasnevin CampusDublin 9Ireland
| | - E. Doherty
- J.E. Cairnes School of Business & EconomicsNational University of Ireland GalwayGalwayIreland
| | - S. Guerin
- UCD Centre for Disability StudiesUCD School of Psychology, University College DublinDublinIreland
| | - J. Schreiber
- School of NursingDuquesne UniversityPittsburghPAUSA
| | - M. Barrett
- Children's Health Ireland (CHI) at CrumlinDublinIreland
- UCD School of MedicineUCD College of Health and Agricultural SciencesDublinIreland
| | - E. McAuliffe
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS)UCD School of Nursing, Midwifery and Health Systems, UCD College of Health and Agricultural SciencesDublinIreland
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Sen B, Brisendine AE, Ghosh P. Disruption of Pediatric Emergency Department Use during the COVID-19 Pandemic. South Med J 2022; 115:250-255. [PMID: 35365840 PMCID: PMC8945392 DOI: 10.14423/smj.0000000000001383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
There is growing evidence that there were substantial declines in pediatric emergency department utilization in the United States in the early months of the coronavirus disease 2019 pandemic. Less is known about whether utilization changed differentially for children who are socioeconomically disadvantaged. This study examined how changes in pediatric emergency department visits during the early months of the coronavirus disease 2019 pandemic differed by two markers of socioeconomic disadvantage: minoritized race and being publicly insured. Objectives There is evidence of substantial declines in pediatric emergency department (ED) utilization in the United States in the first several months of the coronavirus disease 2019 (COVID-19) pandemic. Less is known about whether utilization changed differentially for socioeconomically disadvantaged children. This study examined how changes in pediatric ED visits during the initial months of the COVID-19 pandemic differed by two markers of socioeconomic disadvantage: minoritized race (MR) (compared with non-Hispanic White [NHW]), and publicly insured (compared with privately insured). Methods This study used electronic medical records from a large pediatric ED for the period January to June 2020. Three time periods in 2020 were compared with corresponding time periods in 2019. Changes in overall visits, visits for MR versus NHW children, and Medicaid-enrolled versus privately insured children were considered, and changes in the acuity mix of ED visits and share of visits resulting in inpatient admits were inspected. Results Compared with 2019, total ED visits declined in time period (TP) 1 and TP2 of 2020 (54.3%, 48.9%). Declines were larger for MR children (57.3%, 57.8%) compared with NHW children (50.5%, 39.3%), and Medicaid enrollees (56.5%, 52.0%) compared with privately insured (48.3%, 39.0%). The MR children group experienced steeper percentage declines in high-acuity visits and visits, resulting in inpatient admissions compared with NHW children. In contrast, there was little evidence of difference between TP0s of 2019 and 2020. Conclusions The role of socioeconomic disadvantage and the potential effects on pediatric ED visits during COVID-19 is understudied. Because disadvantaged children sometimes lack access to a usual source of health care, this raises concerns about unmet health needs and worsening health disparities.
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Affiliation(s)
- Bisakha Sen
- From the Department of Health Care Organization and Policy, School of Public Health, and the Department of Pediatrics, Division of Pediatric Emergency Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Anne E Brisendine
- From the Department of Health Care Organization and Policy, School of Public Health, and the Department of Pediatrics, Division of Pediatric Emergency Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Pallavi Ghosh
- From the Department of Health Care Organization and Policy, School of Public Health, and the Department of Pediatrics, Division of Pediatric Emergency Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham
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Ropers F, Bossuyt P, Maconochie I, Smit FJ, Alves C, Greber-Platzer S, Moll HA, Zachariasse J. Practice variation across five European paediatric emergency departments: a prospective observational study. BMJ Open 2022; 12:e053382. [PMID: 35361639 PMCID: PMC8971764 DOI: 10.1136/bmjopen-2021-053382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To compare paediatric healthcare practice variation among five European emergency departments (EDs) by analysing variability in decisions about diagnostic testing, treatment and admission. DESIGN AND POPULATION Consecutive paediatric visits in five European EDs in four countries (Austria, Netherlands, Portugal, UK) were prospectively collected during a study period of 9-36 months (2012-2015). PRIMARY OUTCOME MEASURES Practice variation was studied for the following management measures: lab testing, imaging, administration of intravenous medication and patient disposition after assessment at the ED. ANALYSIS Multivariable logistic regression was used to adjust for general patient characteristics and markers of disease severity. To assess whether ED was significantly associated with management, the goodness-of-fit of regression models based on all variables with and without ED as explanatory variable was compared. Management measures were analysed across different categories of presenting complaints. RESULTS Data from 111 922 children were included, with a median age of 4 years (IQR 1.7-9.4). There were large differences in frequencies of Manchester Triage System (MTS) urgency and selected MTS presentational flow charts. ED was a significant covariate for management measures. The variability in management among EDs was fairly consistent across different presenting complaints after adjustment for confounders. Adjusted OR (aOR) for laboratory testing were consistently higher in one hospital while aOR for imaging were consistently higher in another hospital. Iv administration of medication and fluids and admission was significantly more likely in two other hospitals, compared with others, for most presenting complaints. CONCLUSIONS Distinctive hospital-specific patterns in variability of management could be observed in these five paediatric EDs, which were consistent across different groups of clinical presentations. This could indicate fundamental differences in paediatric healthcare practice, influenced by differences in factors such as organisation of primary care, diagnostic facilities and available beds, professional culture and patient expectations.
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Affiliation(s)
- Fabienne Ropers
- Willem-Alexander Children's Hospital, department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Patrick Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, Amstersdam, Netherlands
| | - Ian Maconochie
- Department of Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Frank J Smit
- Department of Paediatrics, Maasstad Hospital, Rotterdam, Netherlands
| | - Claudio Alves
- General Paediatrics, Emergency Unit, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Portugal
| | - Susanne Greber-Platzer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Wien, Austria
| | - Henriette A Moll
- Department of General Paediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joany Zachariasse
- Department of General Paediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
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Nicholson E, Conlon C, Mimmo L, Doherty E, Guerin S. Unscheduled healthcare for children with intellectual disabilities: A systematic scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:736-751. [PMID: 35322908 PMCID: PMC9314007 DOI: 10.1111/jar.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/30/2022]
Abstract
Background The provision of unscheduled healthcare for children with intellectual disability is less researched than that focused on hospital settings or for adult services. The aim of the scoping review was to map the evidence base in this area and identify areas for future study. Method A five‐stage scoping review framework was adopted. CINAHL, PubMed, SCOPUS, PsycINFO, Embase, ProQuest Dissertation & Theses and Google Scholar were searched. Studies published in English after 1/1/2000 were considered eligible for inclusion. Results A total of 3158 titles and abstracts were screened, 137 full‐text articles were reviewed, and 25 papers met the inclusion criteria. Descriptive themes focused on inequities, needs and experiences of families', poor GP training, and limitations of existing evidence. Conclusion Describing trends in healthcare utilisation by this population is valuable for monitoring quality of healthcare, however, addressing observed inequities will require approaches that recognise specific issues within the health system that result in inequities.
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Affiliation(s)
- Emma Nicholson
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland.,School of Psychology, Faculty of Science and Health, Dublin City University, Dublin, Ireland
| | - Ciara Conlon
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Laurel Mimmo
- School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Edel Doherty
- J.E. Cairnes School of Business & Economics, National University of Ireland Galway, Galway, Ireland
| | - Suzanne Guerin
- UCD Centre for Disability Studies, UCD School of Psychology, University College Dublin, Dublin, Ireland
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McDonnell T, Nicholson E, Bury G, Collins C, Conlon C, Denny K, O'Callaghan M, McAuliffe E. Policy of free GP care for children under 6 years: The impact on daytime and out-of-hours general practice. Soc Sci Med 2022; 296:114792. [DOI: 10.1016/j.socscimed.2022.114792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
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Sen BP, Brisendine A, Yang N, Ghosh P. Disparities by race and insurance-status in declines in pediatric ED utilization during the COVID19 pandemic. PLoS One 2022; 17:e0262490. [PMID: 35139099 PMCID: PMC8827414 DOI: 10.1371/journal.pone.0262490] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/27/2021] [Indexed: 11/19/2022] Open
Abstract
Pediatric Emergency Department (ED) utilization in the U.S. saw large declines during the COVID19 pandemic. What is relatively unexplored is whether the extent of declines differed by race and insurance status. An observational study was conducted using electronic medical record (EMR) data from the largest pediatric ED in Alabama for 2020 and 2019. The four subgroups of interest were African-American (AA), Non-Hispanic White (NHW), privately insured (PRIVATE), and publicly insured or self-insured (PUBLIC-SELF). Percentage changes in the 7-day moving average between dates in 2020 and 2019 were computed for total and high-severity ED visits by subgroup. Trends in percentage changes were plotted. T-tests were used to compare mean changes between subgroups. Large percentage declines in total ED visits and somewhat smaller percentage declines in high-severity visits were observed from March 2020. Declines were consistently larger for AA than NHW and for PUBLIC-SELF than PRIVATE. T-test results indicated mean date-specific percentage declines were significantly larger for AA than NHW for total visits (-38.92% [95% CI: -41.1, -36.8] versus -29.11% [95% CI: -30.8, -27.4]; p<0.001) and high-severity visits (-24.31% [95% CI: -26.2, -22.4] versus -19.49% [95% CI:-21.2, -17.8]; p<0.001), and larger for PUBLIC-SELF than PRIVATE for total visits (-36.32% [95% CI:-38.4, -34.3] versus 27.63% [95% CI:-29.2, -26.0]; p<0.001) and high-severity visits (-21.72% [95% CI: -23.5, -19.9] versus -20.01% [95% CI: -21.7, -18.3]; p = 0.04). In conclusion, significant differences by race and insurance status were observed in the decline in ED visits during the COVID19 pandemic, including high-severity visits. Minority-race and publicly insured or self-insured children often depend on the ED for health needs, lacking a usual source of care. Thus, these findings have worrisome implications regarding unmet healthcare needs and future exacerbations in health disparities.
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Affiliation(s)
- Bisakha Pia Sen
- Department of Health Care Organization & Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, United States of America
| | - Anne Brisendine
- Department of Health Care Organization & Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, United States of America
| | - Nianlan Yang
- SHP Research Collaborative, School of Health Professions, University of Alabama at Birmingham (UAB), Birmingham, Alabama, United States of America
| | - Pallavi Ghosh
- Division of Pediatric Emergency Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, United States of America
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Impact of the COVID-19 Pandemic on the Pediatric Hospital Visits: Evidence from the State of Florida. Pediatr Rep 2022; 14:58-70. [PMID: 35225879 PMCID: PMC8883905 DOI: 10.3390/pediatric14010010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 12/28/2022] Open
Abstract
Although early evidence reported a substantial decline in pediatric hospital visits during COVID-19, it is unclear whether the decline varied across different counties, particularly in designated Medically Underserved Areas (MUA). The objective of this study is to explore the state-wide impact of COVID-19 on pediatric hospital visit patterns, including the economic burden and MUA communities. We conducted a retrospective observational study of pediatric hospital visits using the Florida State all-payer Emergency Department (ED) and Inpatient dataset during the pandemic (April-September 2020) and the same period in 2019. Pediatric Treat-and-Release ED and inpatient visit rates were compared by patient demographics, socioeconomic, diagnosis, MUA status, and hospital characteristics. Pediatric hospital visits in Florida decreased by 53.7% (62.3% in April-June, 44.2% in July-September) during the pandemic. The Treat-and-Release ED and inpatient visits varied up to 5- and 3-fold, respectively, across counties. However, changes in hospital visits across MUA counties were similar compared with non-MUA counties except for lower Treat-and-Release ED volume in April-May. The disproportional decrease in visits was notable for the underserved population, including Hispanic and African American children; Medicaid coverages; non-children's hospitals; and diagnosed with respiratory diseases, appendicitis, and sickle-cell. Florida Hospitals experienced a USD 1.37 billion (average USD 8.3 million) decline in charges across the study period in 2020. Disproportionate decrease in hospital visits, particularly in the underserved population, suggest a combined effect of the persistent challenge of care access and changes in healthcare-seeking behavior during the pandemic. These findings suggest that providers and policymakers should emphasize alternative interventions/programs ensuring adequate care during the pandemic, particularly for high-risk children.
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Overmann KM, Vukovic AA, Britto MT. A Content Analysis of Emergency Department Discharge Instructions for Acute Pediatric Febrile Illnesses: The Current State and Opportunities for Improvement. J Patient Exp 2021; 8:23743735211060773. [PMID: 34869843 PMCID: PMC8640326 DOI: 10.1177/23743735211060773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Quality emergency department (ED) discharge communication is critical to understanding of disease progression, home management, and return instructions. Addressing social aspects of disease burden are important to improving satisfaction and healthcare utilization. The objective of this study was to understand the extent to which written ED discharge instructions address multifaceted aspects of disease to meet the comprehensive needs of families with common childhood illnesses. We analyzed a national sample of 28 written discharge instructions from pediatric EDs using thematic and inductive content analysis. Seven themes were identified. Nearly all discharge instructions devoted a majority of content to themes related to disease physiology. Other themes common to instructions were related to parental instructions for caring for the child and when to return for further care. Content on caregiver reassurance, returning to daily activities, improving well-being, and promoting community health were not a focus of discharge instructions. Inclusion of multifaceted discharge materials which address both medical and social aspects of disease may help improve family-centered emergency care and the quality of care transitions for common childhood illnesses.
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Affiliation(s)
- Kevin M Overmann
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Adam A Vukovic
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Maria T Britto
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Watson G, Pickard L, Williams B, Hargreaves D, Blair M. 'Do I, don't I?' A qualitative study addressing parental perceptions about seeking healthcare during the COVID-19 pandemic. Arch Dis Child 2021; 106:1118-1124. [PMID: 33692082 PMCID: PMC7948150 DOI: 10.1136/archdischild-2020-321260] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Paediatric emergency departments have seen reduced attendance during the COVID-19 pandemic. Late paediatric presentations may lead to severe illness and even death. Maintaining provision of healthcare through a pandemic is essential. This qualitative study aims to identify changing care-seeking behaviours in child health during the pandemic and ascertain parental views around barriers to care. METHODS Semistructured interviews were conducted with caregivers of children accessing acute paediatric services in a hospital in North-West London. Thematic content analysis was used to derive themes from the data, using a deductive approach. RESULTS From interviews with 15 caregivers an understanding was gained of care-seeking behaviours during the pandemic. Themes identified were; influencers of decision to seek care, experience of primary care, other perceived barriers, experiences of secondary care, advice to others following lived experience. Where delays in decision to seek care occurred this was influenced predominantly by fear, driven by community perception and experience and media portrayal. Delays in reaching care were focused on access to primary care and availability of services. Caregivers were happy with the quality of care received in secondary care and would advise friends to seek care without hesitation, not to allow fear to delay them. CONCLUSION A pandemic involving a novel virus is always a challenging prospect in terms of organisation of healthcare provision. This study has highlighted parental perspectives around access to care and care-seeking behaviours which can inform us how to better improve service functioning during such a pandemic and beyond into the recovery period.
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Affiliation(s)
- Gabriella Watson
- Department of Paediatrics, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Lucy Pickard
- Department of Paediatrics, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Bhanu Williams
- Department of Paediatrics, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Dougal Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Mitch Blair
- Department of Paediatrics, London North West Healthcare NHS Trust, Harrow, London, UK
- Paediatrics, Imperial College London, Harrow, UK
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Elrod J, Mahaleh S, Mohr C, Boettcher M, Dietze N, Hübner U, Koch B, Steinbrink A, Harandipour N, Gräfin von Waldersee E, Shahsavari S, Reinshagen K, Königs I. [Impact and Temporal Evolution of the Corona Pandemic on Pediatric Emergency Care]. KLINISCHE PADIATRIE 2021; 234:33-41. [PMID: 34530471 DOI: 10.1055/a-1519-5928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
HINTERGRUND Die COVID-19 Pandemie hat zu massiven gesellschaftlichen und wirtschaftlichen Einschränkungen geführt. Im Kindesalter wurden elektive Vorsorgeuntersuchung oftmals nicht wahrgenommen und es zeigte sich eine Reduktion der Zahl der Notfallvorstellungen. MATERIAL UND METHODEN In einer retrospektiven Studie erfolgte eine quantitative Auswertung aller Notfallpatienten der 5 Kindernotaufnahmen Hamburgs und der Kinder- und Jugendarztpraxen der Jahre 2019 und 2020. Zusätzlich erfolgte die detaillierte Analyse der Notfallbehandlungen des Altonaer Kinderkrankenhauses während der ersten Phase der Pandemie im Vergleich zum Vorjahr. Zusammenhänge zu den Eckpunkten der Pandemieentwicklung wurden analysiert. Die Berechnung signifikanter Unterschiede in Bezug auf die demographischen Daten und Krankheitsbilder erfolgte mittels Chi- Quadrat und t-Test. ERGEBNISSE In allen 5 pädiatrischen Notaufnahmen Hamburgs zeigte sich eine nahezu gleichförmige Abnahme der Patientenvorstellungen während der Pandemie, ähnlich in den Kinder- und Jugendarztpraxen. Die Zahl der Behandlungen verhielt sich dabei nicht streng gegenläufig zu den Neuinfektionen, sondern korreliert eher mit den Mobilitätsdaten und entsprach somit den gesamtgesellschaftlichen Veränderungen. Während der Pandemie stieg der Anteil häuslicher Unfälle an der Gesamtzahl der Vorstellungen signifikant an. Die Analyse der Diagnosen zeigte unter anderem eine relative Abnahme von (viralen) Infektionskrankheiten. Nicht behandlungspflichtige Erkrankungen führten in der Pandemie seltener zur Vorstellung. Diese Phänomene entlasteten einerseits die Notaufnahmen, bergen aber auch die Gefahr, dass Erkrankungen durch Eltern falsch eingeschätzt werden und eine notwendige ärztliche Vorstellung somit zu spät erfolgt.
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Affiliation(s)
- Julia Elrod
- Department of Pediatric Surgery, AKK Altona Children's Hospital, Hamburg, Deutschland.,Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, UKE Medical School, Hamburg, Deutschland
| | - Simin Mahaleh
- Department of Pediatric Surgery, AKK Altona Children's Hospital, Hamburg, Deutschland
| | - Christoph Mohr
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, UKE Medical School, Hamburg, Deutschland
| | - Michael Boettcher
- Department of Pediatric Surgery, AKK Altona Children's Hospital, Hamburg, Deutschland.,Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, UKE Medical School, Hamburg, Deutschland
| | - Nina Dietze
- Department of Pediatric Surgery, AKK Altona Children's Hospital, Hamburg, Deutschland.,Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, UKE Medical School, Hamburg, Deutschland
| | - Uwe Hübner
- Departments of Paediatric Surgery, Catholic Children's Hospital Wilhelmstift, Hamburg, Deutschland
| | - Bernward Koch
- KinderHeidberg, Department of Pediatric Surgery, Asklepios Klinik Nord Heidberg, Hamburg, Deutschland
| | - Annika Steinbrink
- Department of Pediatric Surgery, Helios Mariahilf Klinik Hamburg, Hamburg, Deutschland
| | - Nasanin Harandipour
- Department of Psychosomatic Medicine and Psychotherapy, Schön Klinik Hamburg Eilbek, Hamburg, Deutschland
| | | | - Sadaf Shahsavari
- Clinic and Polyclinic for Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, UKE Medical School, Hamburg, Deutschland
| | - Konrad Reinshagen
- Department of Pediatric Surgery, AKK Altona Children's Hospital, Hamburg, Deutschland.,Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, UKE Medical School, Hamburg, Deutschland
| | - Ingo Königs
- Department of Pediatric Surgery, AKK Altona Children's Hospital, Hamburg, Deutschland.,Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, UKE Medical School, Hamburg, Deutschland
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Schmucker KA, Camp EA, Jones JL, Ostermayer DG, Shah MI. Factors associated with destination of pediatric EMS transports. Am J Emerg Med 2021; 50:360-364. [PMID: 34455256 DOI: 10.1016/j.ajem.2021.08.047] [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: 06/02/2021] [Revised: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Pediatric patients comprise 13% of emergency medical services (EMS) transports, and most are transported to general emergency departments (ED). EMS transport destination policies may guide when to transport patients to a children's hospital, especially for medical complaints. Factors that influence EMS providers 'decisions about where to transport children are unknown. Our objective was to evaluate the factors associated with pediatric EMS transports to children's hospitals for medical complaints. METHODS We performed a cross-sectional study of a large, urban EMS system over a 12-month period for all transports of patients 0-17 years old. We electronically queried the EMS database for demographic data, medical presentation and management, comorbidities, and documented reasons for choosing destination. Distances to the destination hospital and nearest children's and community hospital (if not the transport destination) were calculated. Univariate and multiple logistic regression analyses were conducted to determine the association between independent variables and the transport destination. RESULTS We identified 10,065 patients, of which 6982 (69%) were for medical complaints. Of these medical complaints, 3518 (50.4%) were transported to a children's hospital ED. Factors associated with transport to a children's hospital include ALS transport, greater transport distance, protocol determination, developmental delay, or altered consciousness. Factors associated with transport to general EDs were older age, unknown insurance status, lower income, greater distance to children's or community hospital, destination determined by closest facility or diversion, abnormal respiratory rate or blood glucose, psychiatric primary impression, or communication barriers present. CONCLUSIONS We found that younger patient age, EMS protocol requirements, and paramedic scene response may influence pediatric patient transport to both children's and community hospitals. Socioeconomic factors, ED proximity, diversion status, respiratory rate, chief complaints, and communication barriers may also be contributing factors. Further studies are needed to determine the generalizability of these findings to other EMS systems.
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Affiliation(s)
- Kyle A Schmucker
- University of Pittsburgh Medical Center, Department of Pediatrics, Section of Emergency Medicine, Pittsburgh, PA, USA.
| | - Elizabeth A Camp
- Baylor College of Medicine, Department of Pediatrics, Section of Emergency Medicine, Houston, TX, USA
| | - Jennifer L Jones
- Baylor College of Medicine, Department of Pediatrics, Section of Emergency Medicine, Houston, TX, USA
| | - Daniel G Ostermayer
- University of Texas Health Science Center, McGovern Medical School, Department of Emergency Medicine, Houston, TX, USA
| | - Manish I Shah
- Baylor College of Medicine, Department of Pediatrics, Section of Emergency Medicine, Houston, TX, USA
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45
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Conlon C, Nicholson E, De Brún A, McDonnell T, McAuliffe E. Stuff you think you can handle as a parent and stuff you can't'. Understanding parental health-seeking behaviour when accessing unscheduled care: A qualitative study. Health Expect 2021; 24:1649-1659. [PMID: 34228872 PMCID: PMC8483205 DOI: 10.1111/hex.13305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/29/2021] [Accepted: 06/02/2021] [Indexed: 02/04/2023] Open
Abstract
Background Unscheduled health care constitutes a significant proportion of health‐care utilization. Parental decision making when accessing unscheduled care for their children is multifaceted and must be better understood to inform policy and practice. Design Nineteen semi‐structured interviews and one focus group (n = 4) with parents of children younger than twelve in Ireland were conducted. Participants had accessed unscheduled care for their children in the past. Data were thematically analysed. Results Parents accessed unscheduled care for their children after reaching capacity to manage the child's health themselves. This was informed by factors such as parental experience, perceived urgency and need for reassurance. Parents considered the necessity to access care and situated their health‐seeking behaviour within a framework of ‘appropriateness’. Where parents sought unscheduled care was largely determined by timely access, and inability to secure a general practitioner (GP) appointment often led parents to access other services. Parents expressed a need for more support in navigating unscheduled care options. Conclusions Better resources to educate and support parents are required, and structural issues, such as accessibility to GPs, need to be addressed to enable parents to better navigate the unscheduled health system and manage their children's health. The discourse around ‘appropriate’ and ‘inappropriate’ access to health care has permeated parental decision making when accessing unscheduled health care for their children. What constitutes appropriate access should be examined, and a shift away from this framing of health‐seeking behaviour may be warranted. Patient or Public Contribution There was no explicit patient or public involvement. All authors hold experience as users of the health system.
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Affiliation(s)
- Ciara Conlon
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Emma Nicholson
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Therese McDonnell
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
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46
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Milne-Ives M, Neill S, Bayes N, Blair M, Blewitt J, Bray L, Carrol ED, Carter B, Dawson R, Dimitri P, Lakhanpaul M, Roland D, Tavare A, Meinert E. Impact of Digital Educational Interventions to Support Parents Caring for Acutely Ill Children at Home and Factors That Affect Their Use: Protocol for a Systematic Review. JMIR Res Protoc 2021; 10:e27504. [PMID: 34228628 PMCID: PMC8280832 DOI: 10.2196/27504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/04/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background Urgent and emergency care health services are overburdened, and the use of these services by acutely ill infants and children is increasing. A large proportion of these visits could be sufficiently addressed by other health care professionals. Uncertainty about the severity of a child’s symptoms is one of many factors that play a role in parents’ decisions to take their children to emergency services, demonstrating the need for improved support for health literacy. Digital interventions are a potential tool to improve parents’ knowledge, confidence, and self-efficacy at managing acute childhood illness. However, existing systematic reviews related to this topic need to be updated and expanded to provide a contemporary review of the impact, usability, and limitations of these solutions. Objective The purpose of this systematic review protocol is to present the method for an evaluation of the impact, usability, and limitations of different types of digital educational interventions to support parents caring for acutely ill children at home. Methods The review will be structured using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and Population, Intervention, Comparator, and Outcome (PICO) frameworks. Five databases will be systematically searched for studies published in English during and after 2014: Medline, EMBASE, CINAHL, APA PsycNet, and Web of Science. Two reviewers will independently screen references’ titles and abstracts, select studies for inclusion based on the eligibility criteria, and extract the data into a standardized form. Any disagreements will be discussed and resolved by a third reviewer if necessary. Risk of bias of all studies will be assessed using the Mixed-Methods Appraisal Tool (MMAT), and a descriptive analysis will be used to evaluate the outcomes reported. Results The systematic review will commence during 2021. Conclusions This systematic review will summarize the impact, usability, and limitations of digital interventions for parents with acutely ill children. It will provide an overview of the field; identify reported impacts on health and behavioral outcomes as well as parental knowledge, satisfaction, and decision making; and identify the factors that affect use to help inform the development of more effective and sustainable interventions. International Registered Report Identifier (IRRID) PRR1-10.2196/27504
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Affiliation(s)
- Madison Milne-Ives
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Sarah Neill
- School of Nursing and Midwifery, University of Plymouth, Plymouth, United Kingdom
| | - Natasha Bayes
- Faculty of Health and Society, University of Northampton, Northampton, United Kingdom.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Mitch Blair
- Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Lucy Bray
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Enitan D Carrol
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Rob Dawson
- Meningitis Research Foundation, Bristol, United Kingdom
| | - Paul Dimitri
- Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Monica Lakhanpaul
- UCL - Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, United Kingdom.,Paediatric Emergency Medicine Leicester Academic group, Children's Emergency Department, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Alison Tavare
- West of England Academic Health Science Network, Bristol, United Kingdom
| | - Edward Meinert
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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47
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The Socioeconomic Characteristics of Childhood Injuries in Regional Victoria, Australia: What the Missing Data Tells Us. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137005. [PMID: 34209051 PMCID: PMC8296858 DOI: 10.3390/ijerph18137005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/16/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022]
Abstract
Background: Injury is the leading cause of death among those between 1–16 years of age in Australia. Studies have found that injury rates increase with socioeconomic disadvantage. Rural Urgent Care Centres (UCC) represent a key point of entry into the Victorian healthcare system for people living in smaller rural communities, often categorised as lower socio-economic groups. Emergency presentation data from UCCs is not routinely collated in government datasets. This study seeks to compare socioeconomic characteristics of children aged 0–14 attending a UCC to those who attend a 24-h Emergency Departments with an injury-related emergency presentation. This will inform gaps in our current understanding of the links between socioeconomic status and childhood injury in regional Victoria. Methods: A network of rural hospitals in South West Victoria, Australia provide ongoing detailed de-identified emergency presentation data as part of the Rural Acute Hospital Data Register (RAHDaR). Data from nine of these facilities was extracted and analysed for children (aged 0–14 years) with any principal injury-related diagnosis presenting between 1 February 2017 and 31 January 2020. Results: There were 10,137 injury-related emergency presentations of children aged between 0–14 years to a participating hospital. The relationship between socioeconomic status and injury was confirmed, with overall higher rates of child injury presentations from those residing in areas of Disadvantage. A large proportion (74.3%) of the children attending rural UCCs were also Disadvantaged. Contrary to previous research, the rate of injury amongst children from urban areas was significantly higher than their more rural counterparts. Conclusions: Findings support the notion that injury in Victoria differs according to socioeconomic status and suggest that targeted interventions for the reduction of injury should consider socioeconomic as well as geographical differences in the design of their programs.
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48
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Freedman SB, Roskind CG, Schuh S, VanBuren JM, Norris JG, Tarr PI, Hurley K, Levine AC, Rogers A, Bhatt S, Gouin S, Mahajan P, Vance C, Powell EC, Farion KJ, Sapien R, O'Connell K, Poonai N, Schnadower D. Comparing Pediatric Gastroenteritis Emergency Department Care in Canada and the United States. Pediatrics 2021; 147:e2020030890. [PMID: 34016656 PMCID: PMC8785749 DOI: 10.1542/peds.2020-030890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Between-country variation in health care resource use and its impact on outcomes in acute care settings have been challenging to disentangle from illness severity by using administrative data. METHODS We conducted a preplanned analysis employing patient-level emergency department (ED) data from children enrolled in 2 previously conducted clinical trials. Participants aged 3 to <48 months with <72 hours of gastroenteritis were recruited in pediatric EDs in the United States (N = 10 sites; 588 participants) and Canada (N = 6 sites; 827 participants). The primary outcome was an unscheduled health care provider visit within 7 days; the secondary outcomes were intravenous fluid administration and hospitalization at or within 7 days of the index visit. RESULTS In adjusted analysis, unscheduled revisits within 7 days did not differ (adjusted odds ratio [aOR]: 0.72; 95% confidence interval (CI): 0.50 to 1.02). At the index ED visit, although participants in Canada were assessed as being more dehydrated, intravenous fluids were administered more frequently in the United States (aOR: 4.6; 95% CI: 2.9 to 7.1). Intravenous fluid administration rates did not differ after enrollment (aOR: 1.4; 95% CI: 0.7 to 2.8; US cohort with Canadian as referent). Overall, intravenous rehydration was higher in the United States (aOR: 3.8; 95% CI: 2.5 to 5.7). Although hospitalization rates during the 7 days after enrollment (aOR: 1.1; 95% CI: 0.4 to 2.6) did not differ, hospitalization at the index visit was more common in the United States (3.9% vs 2.3%; aOR: 3.2; 95% CI: 1.6 to 6.8). CONCLUSIONS Among children with gastroenteritis and similar disease severity, revisit rates were similar in our 2 study cohorts, despite lower rates of intravenous rehydration and hospitalization in Canadian-based EDs.
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Affiliation(s)
- Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada;
| | - Cindy G Roskind
- Department of Emergency Medicine, Medical Center, Columbia University, New York, New York
| | - Suzanne Schuh
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - John M VanBuren
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Jesse G Norris
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Katrina Hurley
- Department of Emergency Medicine, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Adam C Levine
- Department of Emergency Medicine, Hasbro Children's Hospital, Rhode Island Hospital and Brown University, Providence, Rhode Island
| | - Alexander Rogers
- Departments of Emergency Medicine and Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Seema Bhatt
- Division of Emergency Medicine, Department of Pediatrics, College of Medicine, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Serge Gouin
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Prashant Mahajan
- Departments of Emergency Medicine and Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Cheryl Vance
- Departments of Emergency Medicine and Pediatrics, School of Medicine, University of California, Davis, Sacramento, California
| | - Elizabeth C Powell
- Department of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ken J Farion
- Division of Emergency Medicine, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Robert Sapien
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Karen O'Connell
- Departments of Pediatrics and Emergency Medicine, School of Medicine and Health Sciences, George Washington University and Children's National Hospital, Washington, DC; and
| | - Naveen Poonai
- Departments of Paediatrics, Internal Medicine, and Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, Ontario, Canada
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49
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McDonnell T, Nicholson E, Barrett M, Bury G, Collins C, Cummins F, Deasy C, Denny K, De Brún A, Hensey C, McAuliffe E. Policy of free GP care for children under 6 years: The impact on emergency department attendance. Soc Sci Med 2021; 279:113988. [PMID: 34022677 DOI: 10.1016/j.socscimed.2021.113988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/30/2021] [Accepted: 04/29/2021] [Indexed: 11/15/2022]
Abstract
Universal health coverage (UHC) aims to improve child health. Ireland, the only country in the European Union without universal access to primary care, introduced general practitioner (GP) care at no charge for children aged under six in 2015. This paper aims to evaluate the impact of this policy on attendance at the emergency department (ED). A difference-in-difference (DiD) analysis was applied to visit records of 367,000 paediatric patients at five hospitals over a period of five years, with treatment and control differentiated by age. DiD was also used to assess if GP referrals and the severity of presentations altered as a consequence of this policy. While existing research estimates that this policy increased attendance by children aged under six at general practice by over 25%, this policy did not lead to a reduction in ED attendance. Hospital level effects on attendance varied from no impact to increased attendance by children aged under six of 28.9%. While increased GP referrals, particularly for injury and medical reasons, indicated more patients presented to their GP prior to ED attendance, walk-ins without referral did not decrease. Attendance increased at both regional hospitals, which also had the highest proportion of GP referred visits. While the marginal probability of a visit being GP referred increased at four of the five hospitals in this study, only in two of these can the entire effect be attributed to the introduction of this policy (effects 1.4 and 1.8 percentage points). Previous unmet need, capacity constraints in general practice, regional variability in the GP to population ratio, restricted hours of access to GPs, coupled with faster access to diagnostics in the ED setting, may explain variability in the effect and why the expected reduction in ED attendances did not occur.
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Affiliation(s)
- Thérèse McDonnell
- IRIS Centre, School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland.
| | - Emma Nicholson
- IRIS Centre, School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland
| | - Michael Barrett
- Children's Health Ireland at Crumlin, Dublin, Ireland; Women's and Children's Health, School of Medicine, University College Dublin, Ireland; National Children's Research Centre, Dublin, Ireland
| | - Gerard Bury
- School of Medicine, University College Dublin, Ireland
| | - Claire Collins
- Irish College of General Practitioners (ICGP), Dublin, Ireland
| | - Fergal Cummins
- ALERT, REDSPOT, Emergency Department, Limerick University Hospital, Limerick, Ireland
| | | | - Kevin Denny
- School of Economics & Geary Institute of Public Policy, University College Dublin, Ireland
| | - Aoife De Brún
- IRIS Centre, School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland
| | - Conor Hensey
- Children's Health Ireland at Temple St, Dublin, Ireland
| | - Eilish McAuliffe
- IRIS Centre, School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland
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50
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DeLaroche AM, Rodean J, Aronson PL, Fleegler EW, Florin TA, Goyal M, Hirsch AW, Jain S, Kornblith AE, Sills MR, Wells JM, Neuman MI. Pediatric Emergency Department Visits at US Children's Hospitals During the COVID-19 Pandemic. Pediatrics 2021; 147:peds.2020-039628. [PMID: 33361360 DOI: 10.1542/peds.2020-039628] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The impact of the coronavirus disease 2019 (COVID-19) pandemic on pediatric emergency department (ED) visits is not well characterized. We aimed to describe the epidemiology of pediatric ED visits and resource use during the pandemic. METHODS We conducted a cross-sectional study using the Pediatric Health Information System for ED visits to 27 US children's hospitals during the COVID-19 pandemic period (March 15, 2020, to August 31, 2020) and a 3-year comparator period (March 15 to August 31, 2017-2019). ED visit rates, patient and visit characteristics, resource use, and ED charges were compared between the time periods. We specifically evaluated changes in low-resource-intensity visits, defined as ED visits that did not result in hospitalization or medication administration and for which no laboratory tests, diagnostic imaging, or procedures were performed. RESULTS ED visit rates decreased by 45.7% (average 911 026 ED visits over 2017-2019 vs 495 052 visits in 2020) during the pandemic. The largest decrease occurred among visits for respiratory disorders (70.0%). The pandemic was associated with a relative increase in the proportion of visits for children with a chronic condition from 23.7% to 27.8% (P < .001). The proportion of low-resource-intensity visits decreased by 7.0 percentage points, and total charges decreased by 20.0% during the pandemic period. CONCLUSIONS The COVID-19 pandemic was associated with a marked decrease in pediatric ED visits across a broad range of conditions; however, the proportional decline of poisoning and mental health visits was less pronounced. The impact of decreased visits on patient outcomes warrants further research.
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Affiliation(s)
- Amy M DeLaroche
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan;
| | | | - Paul L Aronson
- Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Eric W Fleegler
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Todd A Florin
- Division of Pediatric Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Monika Goyal
- Department of Pediatrics, Children's National Hospital and The George Washington University, Washington, District of Columbia
| | - Alexander W Hirsch
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Shobhit Jain
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | - Aaron E Kornblith
- Division of Emergency Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Marion R Sills
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Colorado, Aurora, Colorado; and
| | - Jordee M Wells
- Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, College of Medicine, The Ohio State University Columbus, Ohio
| | - Mark I Neuman
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
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