Primary paediatric care models and non-urgent emergency department utilization: an area-based cohort study.
BACKGROUND
The aim of this study was to evaluate the association between different primary paediatric practice models (individual, network -affiliated but in separate office-, and group practice) and non urgent utilization of the Emergency Department (ED).


METHODS
The data sources were: the 2006 Regional Paediatric Patient files (0-6 years old), the Regional Community-based paediatrician (CBP) file and the 2006 Emergency Information System. We recorded and studied the ED visits of children, excluding planned ED visits, visits for trauma/poisoning and those that were assigned non deferrable/critical triage codes. A multivariate logistic regression was applied to estimate the adjusted odds ratio of an ED visit. The exposure was the type of paediatric practice that served the child: individual, network or group practice. Various characteristics of the child were considered.


RESULTS
The cohort was composed of 293,662 children. In the 2006, 43,347 ED visits occurred (147.6 per 1000). Multivariate logistic models showed lower ED use for group paediatrician patients (OR 0.84; 95%CI 0.73-0.96) and for network paediatrician patients (OR 0.92; 95%CI 0.85-1.00) compared to patients served by an individual practice.


CONCLUSIONS
This study shows that there is a weak association between the type of paediatrician primary practice and emergency department use. Our results highlight the necessity to continue to improve the organization of paediatrician primary practice, in order to increase patient access to primary paediatric care.
Farchi
Sara
S
Public Health Agency, Lazio region, Via di Santa Costanza, 53 00198 Rome, Italy. farchi@asplazio.it
Polo
Arianna
A
Franco
Francesco
F
Di Lallo
Domenico
D
Guasticchi
Gabriella
G
D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003153:Community Health Services; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006123:Group Practice; D006801:Humans; D007558:Italy; D016015:Logistic Models; D010372:Pediatrics; D010821:Physicians, Family / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D012041:Regional Medical Programs; D014600:Utilization Review