title: Comparison of primary physician patterns of and attitudes on emergency department use.
abstract: OBJECTIVE
  This study aimed to compare physician viewpoints and clinic patterns between primary care providers (PCPs) with high patient emergency department (ED) use (HU) and PCPs with low patient ED use (LU).
  
  
  METHODS
  We conducted a mixed methods descriptive study of quantitative and qualitative data of 22 practices. We compared admission rates, American Academy of Pediatrics guideline adherence, efficiency, medical complexity, and patient satisfaction. Primary care provider interviews regarding ED use practices and perspectives were coded and inductively analyzed using Atlas 6.0 for themes.
  
  
  RESULTS
  Compared with LU, the HU group had a higher admission rate (92 vs 41 admissions per 1000 members, P = 0.005), lower scores in adherence to American Academy of Pediatrics guidelines, and higher scores in satisfaction overall. There were no significant differences in efficiency, medical complexity, PCP communications, timeliness for appointment, satisfaction with after-hour care or likelihood of PCP referral. All PCPs described the EDs' purpose as for things they "cannot handle." The LU group was more likely to identify the ED for emergencies, whereas the HU group had a broader, more ambiguous definition of what they "cannot handle," with parental anxiety identified as a significant factor. In addition, the LU group recognized the need for more parental education about ED use.
  
  
  CONCLUSIONS
  Primary care providers with low patient ED use were more likely to describe the EDs' purpose as being for emergencies and to recognize a need for more parental education about the use of the ED. All physicians struggled with reassuring parents.
authors.affiliation: Children's Hospital Boston, Department of Emergency Medicine, Harvard Medical School, Boston, MA 02116, USA. Joyce.li@childrens.harvard.edu
authors.forename: Joyce
authors.initials: J
authors.lastname: Li
authors.forename: Binita
authors.initials: B
authors.lastname: Patel
authors.forename: Angelo Peter
authors.initials: AP
authors.lastname: Giardino
authors.forename: Kimberly Ann
authors.initials: KA
authors.lastname: Battenfield
authors.forename: Charles Gilbert
authors.initials: CG
authors.lastname: Macias
mesh_terms: D001007:Anxiety; D001291:Attitude of Health Personnel; D004526:Efficiency; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005194:Family Practice; D019983:Guideline Adherence; D006300:Health Services Misuse / Q000517:prevention & control / Q000706:statistics & numerical data; D006801:Humans; D010290:Parents / Q000523:psychology; D010343:Patient Admission / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D010372:Pediatrics; D058007:Physicians, Primary Care / Q000523:psychology*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011364:Professional Practice / Q000706:statistics & numerical data; D011368:Professional-Family Relations; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013781:Texas / Q000453:epidemiology