Introduction
Methods
Study design and participants
Pediatric healthcare in Switzerland and its cost for patients
Outcome and low-acuity definition
Explanatory variables and questionnaire
Statistical analysis
Ethics
Results
Study population characteristics
Characteristics | Study participants N = 778 | Total PED visits during the study perioda N = 46,340 | ||
---|---|---|---|---|
Age: < 1 month | 3 | (0%) | 508 | (1%) |
Age: 1 – 11 months | 94 | (12%) | 6136 | (13%) |
Age: 12 – 23 months | 108 | (14%) | 5901 | (13%) |
Age: 2 – 5 years | 216 | (28%) | 13,832 | (30%) |
Age: 6 – 11 years | 212 | (27%) | 12,200 | (26%) |
Age: 12 – 17 years | 145 | (19%) | 7763 | (17%) |
Gender: Female | 388 | (50%) | 21,080 | (45%) |
Accompanied by parent(s) | 731 | (95%) | NA | NA |
ATS 1 | 2 | (0%) | 216 | (0%) |
ATS 2 | 27 | (3%) | 2674 | (6%) |
ATS 3 | 76 | (10%) | 6861 | (15%) |
ATS 4 | 257 | (33%) | 12,222 | (26%) |
ATS 5 | 416 | (54%) | 24,214 | (52%) |
Imaging performed | 200 | (26%) | 8945 | (19%) |
Laboratory study performed | 118 | (15%) | 9434 | (20%) |
Admissions | 67 | (9%) | 4863 | (10%) |
Demographic, socioeconomic characteristics and medical resources
Characteristics | Number of observations available | All PED visits N = 778 | Low-acuity PED visits N = 452 | High-acuity PED visits N = 326 | p-value† | |||
---|---|---|---|---|---|---|---|---|
Age ≤ 5 years | 778 | 374 | (48%) | 241 | (53%) | 133 | (41%) | 0.001 |
Gender: Female | 776 | 388 | (50%) | 218 | (48%) | 170 | (52%) | 0.275 |
First child | 636 | 339 | (53%) | 209 | (52%) | 130 | (56%) | 0.385 |
Only child | 726 | 180 | (25%) | 112 | (26%) | 68 | (23%) | 0.324 |
Any parent < 26 years old | 752 | 35 | (5%) | 26 | (6%) | 9 | (3%) | 0.047 |
Mother without education or mandatory education only | 711 | 105 | (15%) | 67 | (16%) | 38 | (13%) | 0.209 |
Father without education or mandatory education only | 703 | 98 | (14%) | 69 | (17%) | 29 | (10%) | 0.008 |
Mother unemployed | 732 | 187 | (26%) | 121 | (29%) | 66 | (22%) | 0.036 |
Father unemployed | 716 | 47 | (7%) | 32 | (8%) | 15 | (5%) | 0.140 |
Child born in Switzerland | 752 | 671 | (89%) | 388 | (89%) | 283 | (90%) | 0.490 |
Mother born abroad | 744 | 386 | (52%) | 246 | (57%) | 140 | (45%) | 0.001 |
Father born abroad | 727 | 370 | (51%) | 235 | (56%) | 135 | (44%) | 0.003 |
Both parents without family in Switzerland | 727 | 124 | (17%) | 80 | (19%) | 44 | (15%) | 0.133 |
Difficulties to pay household bills | 703 | 141 | (20%) | 102 | (25%) | 39 | (13%) | < 0.001 |
Travel time to PED < 15 min | 766 | 299 | (39%) | 197 | (44%) | 102 | (32%) | 0.001 |
Medical resources | Number of observations available | All PED visits N = 778 | Low-acuity PED visits N = 452 | High-acuity PED visits N = 326 | p-value† | |||
---|---|---|---|---|---|---|---|---|
Has a paediatrician or GP | 756 | 698 | (92%) | 414 | (93%) | 284 | (91%) | 0.167 |
Paediatrician or GP not seen during the last year | 645 | 38 | (6%) | 20 | (5%) | 18 | (7%) | 0.309 |
Asked for medical advice before coming to PED | 638 | 350 | (55%) | 187 | (50%) | 163 | (62%) | 0.002 |
Already visited a PED in the last 6 months | 744 | 275 | (37%) | 186 | (43%) | 89 | (29%) | < 0.001 |
Factors associated with low-acuity PED visits
Characteristics | Adjusted Odds Ratio (95% CI) | |
---|---|---|
Age ≤ 5 years | 1.4 | (1.0 – 2.0) |
Gender: female | 0.8 | (0.6 – 1.2) |
Any parent < 26 years old | 1.2 | (0.4 – 3.3) |
Child born in Switzerland | 0.8 | (0.4 – 1.6) |
Mother born abroad | 1.5 | (0.9 – 2.3) |
Father born abroad | 1.0 | (0.6 – 1.6) |
Difficulties to pay household bills | 2.6 | (1.6 – 4.4) |
Mother without education or mandatory education only | 0.7 | (0.4 – 1.5) |
Father without education or mandatory education only | 1.2 | (0.6 – 2.5) |
Mother unemployed | 0.9 | (0.6 – 1.4) |
Father unemployed | 0.7 | (0.3– 1.6) |
Asked for medical advice before coming to PED | 0.7 | (0.5 – 1.1) |
Already visited a PED in the last 6 months | 1.7 | (1.1 – 2.5) |
Travel time to PED < 15 min | 1.5 | (1.0 – 2.1) |
Difficulties paying households bills in the last 12 months | |||||
---|---|---|---|---|---|
Why did you come to the emergency ward? | Yes N = 141 | No N = 562 | p-value | ||
My child’s problem was too serious | 52 | (37%) | 156 | (28%) | 0.034 |
The Pediatric Emergency ward was the best place for my child’s medical problem | 39 | (28%) | 144 | (26%) | 0.622 |
It would take too long to get an appointment with the doctor | 24 | (17%) | 73 | (13%) | 0.215 |
I can’t visit my doctor within opening hours | 14 | (10%) | 28 | (5%) | 0.027 |
It is close to my home | 1 | (1%) | 9 | (2%) | 0.424 |
I did not think of it | 1 | (1%) | 2 | (0%) | 0.565 |
I have been referred by a healthcare professional | 28 | (20%) | 154 | (28%) | 0.067 |
Other | 17 | (12%) | 53 | (10%) | 0.352 |
I do not know or do not want to answer | 0 | (0%) | 4 | (1%) | 0.315 |