This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Patient-Physician Communication  • Pediatrics, Other  • Primary Care/ Family Medicine  • Emergency Medicine  • Alert me on articles by topic  Social Bookmarking   What's this?

Evidence From the Pediatric Emergency Department Links to Primary Care (PEDLPC) Randomized Controlled Trial

Andrew D. Racine, MD, PhD; Elizabeth M. Alderman, MD; Jeffrey R. Avner, MD

Arch Pediatr Adolesc Med. 2009;163(6):505-511.

Objective  To test whether follow-up phone calls to counsel families about pediatric emergency department (PED) use and primary care availability made after an index PED visit would modify subsequent PED use.

Design  Longitudinal prospective randomized intervention.

Setting  An urban academic children's hospital.

Patients  A total of 4246 individuals aged 0 to 21 years from each of 4 participating primary care practices recording an index PED visit from April through December 2005.

Intervention  Follow-up phone call from the primary care practice within 72 hours of the initial PED visit to counsel about the availability of after-hours advice and when to access the PED.

Main Outcome Measures  All subsequent visits to primary care practices, PED, pediatric subspecialists, or for inpatient hospitalization during a 365-day follow-up period. Logistic and ordinary least squares regressions estimated unadjusted and adjusted odds ratios of follow-up visits, controlling for covariates.

Results  Of the 2166 intervention subjects, 816 (37.7%) recorded follow-up PED visits compared with 819 (39.4%) of the 2080 control subjects (P = .26, not significant). The adjusted odds of a follow-up visit being to the PED rather than to another venue was significantly less for intervention than for control subjects (odds ratio, 0.88; confidence interval, 0.82-0.94), indicating decreased intensity of PED use.

Conclusion  Follow-up phone calls from primary care practices after PED visits counseling patients on the use of primary care and emergency services can modulate subsequent care-seeking behavior and decrease future PED use.

Author Affiliations: Divisions of General Pediatrics (Dr Racine), Adolescent Medicine (Dr Alderman), and Pediatric Emergency Medicine (Dr Avner), Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

This Month in Archives of Pediatrics & Adolescent Medicine
Arch Pediatr Adolesc Med. 2009;163(6):503.
FULL TEXT