title: Adolescent use of the emergency department instead of the primary care provider: who, why, and how urgent?
abstract: OBJECTIVE
  Adolescents frequently rely on emergency medical care, rather than using primary care providers (PCPs). Our objectives were to characterize a population of adolescents presenting to a large, urban emergency department (ED) and to examine the reasons why they present to the ED, rather than to their PCP's office.
  
  
  METHODS
  Adolescents ages 12 to 21 years and their parents/guardians were invited to participate and asked to complete a brief online survey. Demographic data and triage information were collected from electronic medical records.
  
  
  RESULTS
  Of 203 participants, 66% (n = 134) had public insurance, and 40% (n = 82) were triaged as nonurgent. Nearly all (93%, n = 189) reported having a PCP or primary clinic. The most common reasons given for presenting to the ED were participant perception of illness requiring immediate care (34%), followed by PCP referral to the ED (21%). Those with public insurance (odds ratio = 4.44; 95% CI 2.01 to 9.81) or no insurance/unknown insurance status (odds ratio = 4.77; 95% CI 1.34 to 17.01) were more likely to be triaged as nonurgent than those with private insurance.
  
  
  CONCLUSIONS
  Many adolescents in this study were triaged as nonurgent, with several participants perceiving they were acutely ill requiring immediate physician care. Further analyses revealed that private insurance was significantly associated with urgent triage status. Future studies could educate adolescents and families about appropriate use of the ED or examine PCP offices directly to determine practices for phone triage and ED referrals of adolescents.
authors.affiliation: Department of Pediatrics, Adolescent Medicine, University of South Florida, Tampa, Florida. Electronic address: aweiss@health.usf.edu.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weiss
authors.affiliation: Department of Adolescent and Young Adult Medicine, Children's National Medical Center, Washington, DC.
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: D'Angelo
authors.affiliation: Department of Emergency Medicine, Children's National Medical Center, Washington, DC.
authors.forename: Alexandra C
authors.initials: AC
authors.lastname: Rucker
mesh_terms: D000293:Adolescent; D002648:Child; D004219:District of Columbia; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D010290:Parents; D058007:Physicians, Primary Care; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D055815:Young Adult
keywords: Access to health care; Adolescent; Emergency medicine; Primary care physicians