Parental perceptions of avoidability of their child's emergency department visit

Objectives
To identify the factors associated with paediatric emergency department (ED) visits and parental perceptions of the avoidability of their child’s ED visit.

Design
Cross-sectional study by performing secondary analysis of 2010–2011 Iowa Child and Family Household Health Survey data.

Setting
State-wide representative population-based sample of families with at least one child in the state of Iowa in the USA.
Patients/participants Among the eligible households, 2386 families completed the survey, yielding a cooperation rate of 80%.

Exposure/intervention
Presence of a medical home.

Main outcome measures
Child visiting an ED in the past year; parents believing that ED care could have been provided in a primary-care setting.

Results
Among children who needed medical care in the past year, 26% visited an ED. Younger children, non-Hispanic black children, non-Hispanic others, children whose parents were not married, children who were from food-insecure households and had poorer health status were more likely to visit an ED. Having a medical home was not associated with ED visits (OR=0.80, 95% CI 0.61 to 1.04), even after stratifying by the child’s health status. About 69% of parents who took their child to an ED agreed that ED care could have been provided in a primary-care setting. Parents of children with public insurance, those who were not referred to the ED and those who could not get routine care appointments were more likely to report a primary- care preventable ED visit.

Conclusions
The majority of parents believed that paediatric ED visits could be avoided if adequate primary-care alternatives were available. Expanding access to primary care could lead to a reduction in avoidable ED visits by children.