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Comparison of Primary Physician Patterns of and Attitudes on Emergency Department Use

Li, Joyce MD, MPH*; Patel, Binita MD; Giardino, Angelo Peter MD, PhD‡§; Battenfield, Kimberly Ann BS; Macias, Charles Gilbert MD, MPH†§

doi: 10.1097/PEC.0b013e318276c228
Original Articles

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.

From the *Children’s Hospital Boston, Department of Emergency Medicine, Harvard Medical School, Boston MA; and Sections of †Emergency Medicine, and ‡Academic General Pediatrics, §Center for Clinical Effectiveness, ∥Texas Children’s Health Plan, Texas Children’s Hospital, Department of Pediatrics, Baylor College of Medicine, Houston TX.

Disclosure: The authors declare no conflict of interest.

Reprints: Joyce Li, MD, MPH, Children’s Hospital Boston, Harvard Medical School, Department of Emergency Medicine 300 Longwood Ave, Boston MA 02116 (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.