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Parents’ perspective on pediatric emergency department visits for low-acuity conditions before and during the COVID-19 pandemic: a cross-sectional bicentric study

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Abstract

Objectives

The primary objective of this study was to describe and compare the motivation of parents/guardians to bring children with low-acuity conditions to a tertiary-care pediatric emergency department (ED) versus a clinic before and after the pandemic. The secondary objectives were to describe and compare the demographic and clinical characteristics of the population studied and the impact of the pandemic on their access to primary care services.

Methods

This is a cross-sectional study based on a survey administered to parents/guardians of patients presenting with low-acuity conditions at one of two EDs.

Results

The respondents numbered 659. Children were brought to a pediatric ED generally because of the perceived urgency of the condition, the presumed resource availability in the pediatric ED and the unavailability of the primary care physician. However, most respondents (n = 438, 66.5%) indicated preference for a clinic. More respondents before than during the pandemic reported they had been unable to find a doctor outside the ED (48.6% before COVID vs 26.8% during COVID, p < 0.001) but patients during the pandemic were less likely to seek care in a primary care practice or walk-in clinic (30.0% during COVID vs 48.6% before COVID, p < 0.001). In addition, the number of respondents presenting with symptoms of infection decreased by more than half after the pandemic began while the proportion of musculoskeletal and psychiatric complaints doubled.

Conclusion

Although the pandemic has altered the landscape of presenting complaints and pediatric healthcare-seeking behaviors, most respondents indicated they would prefer to receive care in a clinic. This finding contradicts the view that most pediatric ED visits for low-acuity conditions are by choice rather than perceived necessity. Prioritizing improved access to primary care resources would better address the preferences and expectations of parents/guardians.

Abstrait

Objectifs

L’objectif principal de cette étude était de décrire et de comparer la motivation des parents/tuteurs à amener des enfants présentant des troubles de faible sévérité à un service d’urgence (SU) pédiatrique de soins tertiaires par rapport à une clinique avant et après la pandémie. Les objectifs secondaires étaient de décrire et de comparer les caractéristiques démographiques et cliniques de la population étudiée et l’impact de la pandémie sur leur accès aux services de soins primaires.

Méthodes

Il s’agit d’une étude transversale fondée sur une enquête menée auprès de parents/tuteurs de patients présentant des problèmes de faible sévérité à l’un des deux SU.

Résultats

Les répondants étaient au nombre de 659. Les enfants ont été amenés à un SU pédiatrique généralement en raison de l’urgence perçue de la condition, de la disponibilité présumée des ressources dans le SU pédiatrique et de l’indisponibilité du médecin de soins primaires. Cependant, la plupart des répondants (n = 438, 66,5%) ont indiqué une préférence pour une clinique. Plus de répondants avant que pendant la pandémie ont déclaré qu’ils avaient été incapables de trouver un médecin à l’extérieur de l’urgence (48,6% avant la COVID-19 contre 26,8% pendant la COVID-19, p < 0,001), mais les patients pendant la pandémie étaient moins susceptibles de solliciter des soins dans une clinique de soins primaires ou une clinique sans rendez-vous. (30,0% pendant la COVID-19 contre 48,6% avant la COVID-19, p < 0,001). De plus, le nombre de répondants présentant des symptômes d’infection a diminué de plus de la moitié après le début de la pandémie, tandis que la proportion de plaintes musculosquelettiques et psychiatriques a doublé.

Conclusion

Bien que la pandémie ait modifié le portrait des raisons et des habitudes de consultation dans les urgences pédiatriques, la plupart des répondants ont indiqué qu’ils préféreraient recevoir des soins dans une clinique. Cette constatation contredit le point de vue selon lequel la plupart des visites aux urgences pédiatriques pour des problèmes de faible sévérité se font par choix plutôt que par nécessité perçue. Donner la priorité à l’amélioration de l’accès aux ressources de soins primaires permettrait de mieux répondre aux préférences et aux attentes des parents/tuteurs.

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Data availability

The data sets generated during this study are available from the corresponding author on reasonable request.

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Acknowledgements

Dr. Berthelot, Dr. Samman and Dr. Le are the primary authors of this study and have been involved from the protocol elaboration to the manuscript redaction for both centers. Dr. Burstein was involved as the primary contact researcher at the McGill university center. Myriam Mallet acted as the research assistant at the CHUL. David Simonyan was involved for statistics. Dr. Rehimini, Dr. Grenier and Miss Bertrand-Bureau were responsible of data collection for both centers. All the co-authors have had the opportunity to review the final manuscript and have provided their permission to publish the manuscript.

Funding

This work funded by Fondation du CHU de Québec to Cathie-Kim Le, and by Fédération des Médecins Résidents du Québec and Groupe de recherche en médecine d’urgence du CHUL (GREMUC) to Karol Samman.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Centre Hospitalier Régional de Lanaudière, St-Charles-Borromée, QC, Canada

    Karol Samman

  2. Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montréal, QC, Canada

    Cathie-Kim Le & Brett Burstein

  3. Department of Biostatistics, Epidemiology and Occupational Health, McGill University, Montréal, QC, Canada

    Brett Burstein

  4. McGill University, Montréal, QC, Canada

    Salma Rehimini

  5. Department of Family Medicine, GMF Nouvelle-Beauce, Sainte-Marie, QC, Canada

    Anthony Grenier

  6. Université de Laval, Québec, QC, Canada

    Claudia Bertrand-Bureau

  7. Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada

    Myriam Mallet

  8. CHU de Québec-Université Laval, Québec, QC, Canada

    David Simonyan

  9. Département de médecine de famille et de médecine d’urgence, Université Laval, Québec, QC, Canada

    Simon Berthelot

  10. Centre de recherche du CHU de Québec-Université Laval, Axe Santé des populations et pratiques optimales en santé,, Québec, QC, Canada

    Simon Berthelot

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  1. Karol Samman
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Corresponding author

Correspondence to Simon Berthelot.

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Conflict of interest

Dr. Berthelot and Dr. Burstein are recipients of career awards from the Fonds de recherche du Québec-Santé. The authors have no other conflicts of interest to declare.

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Samman, K., Le, CK., Burstein, B. et al. Parents’ perspective on pediatric emergency department visits for low-acuity conditions before and during the COVID-19 pandemic: a cross-sectional bicentric study. Can J Emerg Med 26, 31–39 (2024). https://doi.org/10.1007/s43678-023-00609-9

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