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Article |

Advice Seeking and Appropriate Use of a Pediatric Emergency Department

T. F. Oberlander, MD, FRCPC; I. B. Pless, MD, FRCPC; G. E. Dougherty, MSc, MD, FRCPC
Am J Dis Child. 1993;147(8):863-867. doi:10.1001/archpedi.1993.02160320065021.
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• Objectives.  —To determine whether seeking advice prior to an unscheduled visit to a pediatric emergency department (PED) influences appropriate use of this setting for minor illnesses.

Design.  —Cross-sectional questionnaire survey.

Setting.  —The medical emergency department of the Montreal (Quebec) Children's Hospital, a major referral and urban teaching hospital.

Participants.  —Four hundred eighty-nine of 562 consecutive parents visiting the PED over two periods, one in February and the other in July 1989.

Interventions.  —None.

Measurements/Main Results.  —Parents of children between 0 and 18 years of age visiting the PED were asked whether they had previously sought advice from family, friends, or a physician. Other factors possibly related to the decision to seek care were also measured. Appropriateness was rated, blind to discharge diagnosis, by two pediatricians using a structured series of questions incorporating the child's age, time of the visit, clinical state, and problem at presentation. Thirty-four percent of visits among respondents were judged appropriate. In bivariate analysis, appropriate visits occurred significantly more often when a parent spoke to both a physician and a nonphysician (47%) prior to visiting the PED than when no advice was sought (29%; P<.05). In multivariate analysis, having a regular physician and being one of two children also contributed to appropriateness.

Conclusions  —Appropriate use of the PED was positively influenced by seeking prior advice from both a physician and family member, having a regular physician, and having prior child care experience.(AJDC. 1993;147:863-867)


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