Low Rates of Follow-Up With Primary Care Providers After Pediatric Emergency Department Visits for Respiratory Tract Illnesses
Low Rates of Follow-Up With Primary Care Providers After Pediatric Emergency Department Visits for Respiratory Tract Illnesses
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DOI：
10.1097/pec.0b013e31826c6dde
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发表时间：
2012-10-01
影响因子：
1.4
通讯作者：
Teach, Stephen J.
中科院分区：
文献类型：
--
作者：
Liberman, Danica B.;Shelef, Deborah Q.;Teach, Stephen J.
目的：我们试图确定因呼吸道疾病到急诊科 (ED) 就诊后初级保健提供者 (PCP) 的具体诊断随访率。我们假设急性传染病患者的随访率会高于哮喘患者。方法：这是一项回顾性队列研究，对象是 0 至 12 岁的患者，这些患者在 12 个月的时间内从城市三级护理儿科急诊室出院，患有 4 种不同的呼吸道疾病（哮喘、细支气管炎、哮吼和肺炎）。检查初级保健提供者的随访与社会人口统计学和临床因素以及随后的急诊就诊之间的关系。结果：整个队列的随访率较低：7 天随访率为 23.6%（95% 置信区间，19.7-27.4），30 天随访率为 40.5%（95% 置信区间，36.0-44.9）。与哮喘患者相比，毛细支气管炎和肺炎患者的 7 和 30 天内随访相对风险 (RR) 显着较高，但哮吼患者则不然。对于整个队列来说，年龄每增加 1 岁，7 天内和 30 天内随访的 RR 显着降低，并且随着提供明确的 ED 出院指示建议随访，7 天内随访的 RR 显着增加。在哮喘患者中，30 天内 PCP 随访与接下来一年因哮喘急诊就诊的次数减少无关。结论：PCP 随访率在全球范围内较低，但对于患有急性传染病的患者、年轻患者以及接受明确的 ED 出院指示的患者来说，PCP 随访率明显较高。
Objectives: We sought to determine diagnosis-specific rates of follow-up with primary care providers (PCPs) after emergency department (ED) visits for respiratory tract illnesses. We hypothesized that follow-up rates would be higher among patients with acute infectious illnesses than among those with asthma.Methods: This was a retrospective cohort study of a random sample of patients aged 0 to 12 years discharged over a 12-month period from an urban, tertiary care pediatric ED with 4 different respiratory tract illnesses (asthma, bronchiolitis, croup, and pneumonia). Primary care provider follow-up was examined for associations with sociodemographic and clinical factors and with subsequent ED visits.Results: Rates of follow-up in the overall cohort were low: 23.6% (95% confidence interval, 19.7-27.4) by 7 days and 40.5% (95% confidence interval, 36.0-44.9) by 30 days. Compared with patients with asthma, the relative risks (RRs) of follow-up within 7 and 30 days were significantly higher among patients with bronchiolitis and pneumonia, but not with croup. For the cohort as a whole, the RR of follow-up within 7 and 30 days significantly decreased for each 1-year increase in age, and the RR of follow-up within 7 days significantly increased with the provision of explicit ED discharge instructions recommending follow-up. Among patients with asthma, follow-up with PCPs within 30 days was not associated with decreased ED visits for asthma over the following year.Conclusions: Rates of PCP follow- up were globally low but significantly higher for patients with acute infectious illnesses, for younger patients, and for those receiving explicit ED discharge instructions.