Comparison of Primary Physician Patterns of and Attitudes on Emergency Department Use

Objective: This study aimed to compare physician viewpoints and clinic patterns between primary care providers (PCPs) with high patient emergency department (ED) use (HU) and PCPs with low patient ED use (LU). Methods: We conducted a mixed methods descriptive study of quantitative and qualitative data of 22 practices. We compared admission rates, American Academy of Pediatrics guideline adherence, efficiency, medical complexity, and patient satisfaction. Primary care provider interviews regarding ED use practices and perspectives were coded and inductively analyzed using Atlas 6.0 for themes. Results: Compared with LU, the HU group had a higher admission rate (92 vs 41 admissions per 1000 members, P = 0.005), lower scores in adherence to American Academy of Pediatrics guidelines, and higher scores in satisfaction overall. There were no significant differences in efficiency, medical complexity, PCP communications, timeliness for appointment, satisfaction with after-hour care or likelihood of PCP referral. All PCPs described the EDs' purpose as for things they "cannot handle." The LU group was more likely to identify the ED for emergencies, whereas the HU group had a broader, more ambiguous definition of what they "cannot handle," with parental anxiety identified as a significant factor. In addition, the LU group recognized the need for more parental education about ED use. Conclusions: Primary care providers with low patient ED use were more likely to describe the EDs' purpose as being for emergencies and to recognize a need for more parental education about the use of the ED. All physicians struggled with reassuring parents.