Accessing care: Right time - right place

Background: The Consortium for Infant and Child Health (CINCH), a leading child health coalition in Hampton Roads, Virginia, focuses on quality primary care for low income Medicaid children. Partnering with the ED at the children's hospital, CINCH sought to better understand the patterns of care associated with non-urgent use ED use. Methods: Focus groups, caregiver surveys, and an assessment of area pediatric practice setting characteristics and barriers to access, such as lack of evening and weekend hours, were conducted to identify opportunities for intervention. Results: Barriers in the system of primary care, such as lack of after-hours care and difficulties in scheduling appointments impacted ED non-urgent care. 90% of caregivers identified the ED as the closest place to seek after-hours care. 68% of pediatric primary care practices offered no evening/weekend hour care. Educational barriers existed, but were less severe than anticipated. Nurse triage call centers were used inconsistently, but were of benefit to some caregivers. Among caregivers who sought advice, 29% were told not to go to the ED, but went anyway. Although 100% of caregivers stated they were comfortable managing their child's illness, they still sought care in the ED. In 2006, nearly half of children were seen in ED for non-urgent conditions. Significant barriers were encountered in collecting data in the ED. Conclusions: Availability of more evening and weekend care might provide reasonable alternatives for caregivers. Systems approaches are needed to eliminate access and system barriers. Caregivers need education on decision making skills related to care seeking.