Deprivation and its impact on non-urgent Paediatric Emergency Department use: are Nurse Practitioners the answer?

Abstract

Aims: This paper reports on the quantitative findings from a large mixed method study that determined the extent to which the provision of alternatives to an Emergency Department, and Index of Relative Social Disadvantage score influenced non-urgent paediatric Emergency Department use. Background: In Australia there is an increasing use of Emergency Departments for the provision of non-urgent care that may be better serviced in the community. Further, despite the plethora of literature describing the characteristics of non-urgent users of Emergency Departments the link to social and community characteristics remains under explored. Design: This 2010 retrospective analysis of the Hospital Admission Status data from the paediatric Emergency Department provided the information on attendance types and numbers along with postcode details. The postcodes in conjunction with Australia Bureau of Statistics data provided the levels of deprivation from the Index of Relative Social Deprivation scores. Method: A logistic regression analysis determined the levels of influence of deprivation and General Practitioner or Nurse Practitioner provision on the use of ED for non-urgent care. Findings: Rates of use for non-urgent care is higher for populations who come from areas of deprivation and have limited primary care services, such as low levels of General Practitioners. Children from areas of high deprivation and limited access to primary care were up to 6 times more likely to use Emergency Department for non-urgent care. Conclusions: Deprivation impacts on the use of paediatric ED for non-urgent care even in countries like Australia where there is government subsidised health care.