Extended primary care office hours might help keep kids out of the emergency department

June 19, 2013

Children had half as many emergency department visits if their primary care office had evening office hours on five or more days a week, according to new research from child health experts at C.S. Mott Children's Hospital and Johns Hopkins University.

The new study was published online this month in The Journal of Pediatrics and will be presented at the AcademyHealth Annual Research Meeting.

"These findings are an important step in understanding where primary care practices and medical home programs can be most effective in making changes to enhance access," says U-M Joe Zickafoose, M.D., M.S., formerly a research fellow with the Child and Research Unit at the University of Michigan C.S. Mott Children's Hospital and now a health researcher with Mathematica Policy Research in Ann Arbor, Mich.

Primary care practices for children around the country are working on ways to make it easier for families to communicate with the practice to get advice and make an appointment. A key goal of these efforts is to help avoid the stress and expense of unnecessary emergency department visits, and extending office hours into the evening might be an effective way to do this, says Zickafoose.

Efforts around the country to improve health care for children have increasingly focused on the "medical home" as a model to make primary care practices more accessible, comprehensive, and focused on quality improvement. A central aspect of the medical home approach is to enhance families' options for accessing their child's primary care practice, including 24-hour phone advice, email or patient portal communication, same-day sick visits, and evening and weekend office hours.

The investigators found that many parents did not know whether enhanced access services were available in their child's primary care office. Children whose parents reported that their offices had evening hours most nights of the week had half the number of emergency department visits compared to other children even after adjusting for factors such as health insurance and household income. But, only half of parents knew whether their child's office was open after 5 PM.

Recent studies have shown that extended office hours seem to decrease emergency department use and some health care costs in adults, but no large studies have looked at practices for children.

The types of changes practices need to make to enhance access can be costly and time consuming, so information about the most effective changes could help practices decide where to commit their resources, Zickafoose says.

Data used in the study came from a national survey of parents. In the survey, parents were asked about characteristics of their child's primary care practice, including 24-hour phone advice, email or patient portal communication, same-day sick visits, and evening and weekend office hours. They were also asked how many times they needed to take their child to the emergency department in the 12 months prior to the survey.

The investigators looked at the association between parents' reports of the "enhanced access services" and the child's emergency department visits, controlling for other factors that are frequently associated with emergency department use.

In this study, other enhanced access services, such as same-day sick visits, were not associated with the rate of visits.

"We hope that our study encourages parents and practices to communicate more about when the office is open and when they can call for advice," says Zickafoose, lead author of the study.

Explore further: Small physician practices that care for children unprepared to become medical homes

More information: Zickafoose JS, DeCamp LR, Prosser LA. Association between Enhanced Access Services in Pediatric Primary Care and Utilization of Emergency Departments: A National Parent Survey. The Journal of Pediatrics. 2013 Jun 4. [Epub ahead of print].

Related Stories

Small physician practices that care for children unprepared to become medical homes

March 7, 2013
Primary care practices around the country are being encouraged and even paid to become "medical homes," but small practices might be at a significant disadvantage in this race to improve health care for children, according ...

More accident and emergency visits where access to GPs is worse

June 12, 2013
Patients with more timely access to GP appointments make fewer visits to accident and emergency departments, suggests a study published today.

One-third of parents concerned about losing jobs, pay when they stay home with sick kids

October 22, 2012
Many child care providers have rules that exclude sick children from care, spurring anxious moments for millions of working parents. In a new University of Michigan poll, one-third of parents of young children report they ...

Only one-third of parents follow doctors' orders for kids all of the time

March 18, 2013
Pediatricians regularly dispense advice to parents of young children during well-child visits, but a new University of Michigan poll shows that many aren't following doctors' orders.

Hospital emergency departments gaining in importance, study finds

May 20, 2013
Hospital emergency departments play a growing role in the U.S. health care system, accounting for a rising proportion of hospital admissions and serving increasingly as an advanced diagnostic center for primary care physicians, ...

Health of nation reviewed with focus on emergency care

June 3, 2013
(HealthDay)—Recent trends in the health of the nation are described, with particular focus on emergency care, in the 36th annual report published by the National Center for Health Statistics (NCHS) and the U.S. Centers ...

Recommended for you

Study shows probiotics can prevent sepsis in infants

August 17, 2017
A research team at the University of Nebraska Medical Center College of Public Health has determined that a special mixture of good bacteria in the body reduced the incidence of sepsis in infants in India by 40 percent at ...

Children who sleep an hour less at higher risk of type 2 diabetes, says study

August 15, 2017
A study has found that children who slept on average one hour less a night had higher risk factors for type 2 diabetes, including higher levels of blood glucose and insulin resistance.

Low blood sugars in newborns linked to later difficulties

August 8, 2017
A newborn condition affecting one in six babies has been linked to impairment in some high-level brain functions that shows up by age 4.5 years.

Can breast milk feed a love of vegetables?

August 4, 2017
(HealthDay)—Want your preschooler to eat veggies without a fuss? Try eating veggies while you're breast-feeding.

Small drop in measles vaccinations would have outsized effect, study estimates

July 24, 2017
Small reductions in childhood measles vaccinations in the United States would produce disproportionately large increases in the number of measles cases and in related public health costs, according to a new study by researchers ...

At the cellular level, a child's loss of a father is associated with increased stress

July 18, 2017
The absence of a father—due to incarceration, death, separation or divorce—has adverse physical and behavioral consequences for a growing child. But little is known about the biological processes that underlie this link ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.