title: Nonurgent pediatric emergency department visits: Care-seeking behavior and parental knowledge of insurance.
abstract: OBJECTIVES The goals of this study were to describe the factors associated with utilization of emergency services for nonurgent illnesses by insured children in a pediatric emergency department (PED) and to assess parental knowledge of their insurance and its influence on care-seeking behaviors. METHODS We conducted a prospective, descriptive survey of parents of insured children evaluated for nonurgent illnesses in an urban PED. RESULTS A total of 251 surveys were completed. The primary reason chosen by the parent for the PED visit was convenience in 62.8% of cases, a perceived true emergency in 33.6%, and lack of other access to a physician in 3.6%. Parents choosing the PED for perceived emergencies were more likely to state that the illness was life threatening or required hospital admission than those who came because of convenience (33/84 vs. 28/157; < 0.001). Only 38.7% stated that they were educated as to what problems are considered emergencies by their insurance carriers. PED referrals for nonurgent complaints are required by the insurance carrier for 74.9% of the population; however, only 37.2% of the parents stated that referrals were necessary. Primary care physician (PCP) contact was made prior to the visit by 45.4% of parents. Of those who called the PCP, 72.6% stated that they were referred to the PED. Of the parents who believed that a referral was required, those stating that the problem was an emergency were more likely to have contacted the PCP than those who came because of convenience (27/37 vs. 22/46; < P 0.037).CONCLUSIONS Parents frequently do not understand their insurance coverage as it relates to emergency care utilization. This lack of knowledge influences their care-seeking behaviors for nonurgent illnesses. Convenience is a significant factor in PED utilization for nonurgent complaints.
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA. kdoobini@chkd.com
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Doobinin
authors.forename: Paris E
authors.initials: PE
authors.lastname: Heidt-Davis
authors.forename: Toni K
authors.initials: TK
authors.lastname: Gross
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Isaacman
mesh_terms: D000328:Adult; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006300:Health Services Misuse; D006776:Hospitals, Pediatric; D006786:Hospitals, Urban; D006801:Humans; D007348:Insurance, Health; D009042:Motivation; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D010372:Pediatrics; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014768:Virginia