The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #69142

Sharon Perry, PhD, Grace Hui, BA, Maria de Luz Sanchez, BA, Marisa Chiang, BA, and Julie Parsonnet, MD. Infectious Diseases, Stanford University, 300 Pasteur Drive, Grant Bldg, S131, Stanford, CA 94305, 650-736-1738, shnperry@stanford.edu

Background: Infectious gastroenteritis (IGE) accounts for a significant portion of annual outpatient visits. The impact of managed care programs for the uninsured on emergency room (ER) utilization for IGE is unknown. Objective: To compare characteristics of gastroenteritis cases presenting at public emergency rooms and clinics. Methods. As part of an ongoing cohort study, households with a case of diarrhea or vomiting of infectious etiology were referred by providers in Santa Clara and San Mateo counties for interview regarding occurrence, onset, and duration of recent IGE. Analysis: Stepwise logistic regression was used to compare characteristics of cases referred by public ER and outpatient clinics. Results: Among 645 index cases of IGE (90% Hispanic), 118 (18%) were referred by a county ER and 527 (82%) were referred by 9 public outpatient clinics, including pediatric (80%) or family medicine (20%) clinics. Duration of symptoms and rates of household IGE were similar in the ER and clinics. Compared to clinic cases, ER cases were older, and more likely to report both diarrhea and vomiting and to present in winter. There were trends for greater use of antibiotic therapy in ER encounters (20% vs. 13%, p=.06), and for Spanish-speaking households to have preferred a clinic (70% vs. 82%, p=.08). Conclusion: In this study of IGE, older children and adults were more likely to use the ER than young children, despite similar clinical symptoms. This finding may reflect targeted enrollment of younger children in publicly insured clinic programs.

Learning Objectives:

• Apply case definition of acute infectious gastroenteritis in community-based epidemiology
• Describe demographic factors and gastrointestinal symptoms associated with use of county public health clinic and emergency room services
• Identify profile of Hispanic families in South San Francisco Bay area

Keywords: Latino Health, Utilization

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.