title: Change in parental reasons for use of an urban pediatric emergency department in the past decade.
abstract: OBJECTIVE
  To assess changes over the past decade in parental reasons associated with nonurgent visits to pediatric emergency departments (PEDs) during regular primary care office hours.
  
  
  METHODS
  Secondary analysis of cross-sectional surveys of families of children younger than 3 years visiting a PED in a low-socioeconomic area in New York City conducted in 1997 and 2006. We performed multivariable analyses to assess differences in parental reported reasons for PED use over the period, controlling for sociodemographic factors.
  
  
  RESULTS
  Most children (95.6%) had a usual source of care across both periods. Compared with those seen in 1997, children seen in 2006 were far less likely to be brought to the PED during regular primary care office hours for parental perceived urgency (adjusted odds ratio [AOR], 0.076; 95% confidence interval [CI], 0.024-0.24; P < 0.001). At the same time, these children were more likely to be brought to the PED for limited access to their usual source of care (AOR, 3.35; 95% CI, 1.24-9.02; P < 0.05) and greater trust in the medical expertise of the PED (AOR, 5.95 95% CI, 1.20-29.45; P < 0.05).
  
  
  CONCLUSIONS
  Over the last decade, despite the presence of a usual source of care, a greater number of parents report visiting this urban PED during regular office hours for reasons unrelated to parental perceived urgency. Limited access to care and greater trust in the medical expertise available in PEDs have played important roles. Approaches to decreasing nonurgent visits must take into account all of these factors.
authors.affiliation: Division of General Pediatrics, Columbia University, New York, NY 10032, USA. mss2112@columbia.edu
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Stockwell
authors.forename: Sally E
authors.initials: SE
authors.lastname: Findley
authors.forename: Matilde
authors.initials: M
authors.lastname: Irigoyen
authors.forename: Raquel Andres
authors.initials: RA
authors.lastname: Martinez
authors.forename: Meridith
authors.initials: M
authors.lastname: Sonnett
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D009519:New York City; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D012959:Socioeconomic Factors; D014505:Urban Population