News: Children without a primary care provider more likely to rely on ED, study finds

Children without an identified primary care provider (PCP) had higher odds of healthcare visits occurring in the emergency department (ED), a recent study led by Lukas K. Gaffney, MD, MPH, of the Division of Emergency Medicine at Boston Children’s Hospital and Harvard Medical School in Boston, found.

Researchers conducted a retrospective cross-sectional study using data from a nationally representative longitudinal survey that included 9,878 children from 2021 to 2022.

Primary care access was determined on the basis of affirmative responses to having a usual source of medical care. Lack of PCP access was associated with a higher likelihood of ED reliance adjusted odds ratio but was not significantly associated with frequent ED utilization.

The primary outcomes were frequent ED utilization, defined as two or more ED visits annually based on previous patterns, and high reliance, calculated as the percentage of healthcare visits occurring in this setting. Among children with a PCP, researchers evaluated associations between specific components of PCP access, such as travel time, ease of contact, east of contact after hours, and availability during nights and weekend.

The surveyed children represented 72.5 million children nationally, 83.2% of which had a PCP. Children younger than one year and those between ages one and five were found to be more likely to have frequent ED utilization than children aged six to 11 years. Among children with identified PCPs, none of the examined access components showed significant associations with either frequent ED utilization or high ED reliance.

“Although having an identified PCP may help mediate ED reliance, its impact is not uniform across all pediatric populations and does not appear to reduce overall ED utilization,” the authors wrote. “The strong and distinct associations found with sociodemographic factors highlight that systemic and social determinants of health are critical drivers of how and why children use the ED.”

Editor’s note: To read the full study, click here. To read additional coverage by Medscape, click here.