title: The impact of primary care on emergency department presentation and hospital admission with pneumonia: a case-control study of preschool-aged children.
abstract: BACKGROUND
  In children, community-acquired pneumonia is a frequent cause of emergency department (ED) presentation and hospital admission. Quality primary care may prevent some of these hospital visits.
  
  
  OBJECTIVE
  The aim of this study was to identify primary care factors associated with ED presentation and hospital admission of preschool-aged children with community-acquired pneumonia.
  
  
  METHODS
  A case-control study was conducted by enrolling three groups: children presenting to the ED with pneumonia and admitted (n = 326), or discharged home (n = 179), and well-neighbourhood controls (n = 351). Interviews with parents and primary care staff were conducted and health record review was performed. The association of primary care factors with ED presentation and hospital admission, controlling for available confounding factors, was determined using logistic regression.
  
  
  RESULTS
  Children were more likely to present to the ED with pneumonia if they did not have a usual general practitioner (GP) (odds ratio (OR) = 2.50, 95% confidence interval (CI) = 1.67-3.70), their GP worked ⩽ 20 h/week (OR = 1.86, 95% CI = 1.10-3.13) or their GP practice lacked an immunisation recall system (OR = 5.44, 95% CI = 2.26-13.09). Lower parent ratings for continuity (OR=1.63, 95% CI = 1.01-2.62), communication (OR = 2.01, 95% CI = 1.29-3.14) and overall satisfaction (OR = 2.16, 95% CI = 1.34-3.47) increased the likelihood of ED presentation. Children were more likely to be admitted when antibiotics were prescribed in primary care (OR = 2.50, 95% CI = 1.43-4.55). Hospital admission was less likely if children did not have a usual GP (OR = 0.22, 95% CI = 0.11-0.40) or self-referred to the ED (OR = 0.48, 95% CI = 0.26-0.89).
  
  
  CONCLUSIONS
  Accessible and continuous primary care is associated with a decreased likelihood of preschool-aged children with pneumonia presenting to the ED and an increased likelihood of hospital admission, implying more appropriate referral. Lower parental satisfaction is associated with an increased likelihood of ED presentation.
authors: 1] Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand [2] Starship Children's Hospital, Auckland, New Zealand.
authors: Diane P
authors: DP
authors: Emery
authors: Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
authors: Tania
authors: T
authors: Milne
authors: Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
authors: Catherine A
authors: CA
authors: Gilchrist
authors: 1] Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand [2] Otago Polytechnic, Dunedin, New Zealand.
authors: Megan J
authors: MJ
authors: Gibbons
authors: School of Population Health, University of Auckland, Auckland, New Zealand.
authors: Elizabeth
authors: E
authors: Robinson
authors: School of Graduate Studies, University of Auckland, Auckland, New Zealand.
authors: Gregor D
authors: GD
authors: Coster
authors: Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA.
authors: Christopher B
authors: CB
authors: Forrest
authors: Department of Primary Health Care Sciences, University of Oxford, Oxford, England.
authors: Anthony
authors: A
authors: Harnden
authors: Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA.
authors: David
authors: D
authors: Mant
authors: 1] Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand [2] Starship Children's Hospital, Auckland, New Zealand.
authors: Cameron C
authors: CC
authors: Grant
mesh_terms: D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000175:diagnosis; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011014:Pneumonia / Q000175:diagnosis; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors
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