Primary Care: Patterns of Use of Pediatric Medical Facilities

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On-site interviews of 750 parents were conducted in three neighborhood health centers (NHC), the affiliated hospital emergency room (ER) and the hospital-based primary care program (CCHP), to determine how parents seeking primary care for their children actually utilized these facilities. Three dimensions define the following modal patterns of use: 1) nature of site (s) used, 2) role of each site, and 3) medical content of care. Five major patterns of use of care emerged which were 1) no primary care—10 per cent, 2) primary care only—19 per cent, 3) comprehensive primary care—34 per cent, 4) limited primary care—33 per cent, and 5) multiple primary care—4 per cent. Factors significantly correlated with these patterns include child's age, recent change in residence, ethnic origin, reasons parents cite for choosing ER care, and parents' overall satisfaction with care. Three patterns (Nos. 1, 4, and 5), which include 47 per cent of the sample, indicate considerable disparity between actual use and intended use of these facilities, e.g., ER is used for nonemergencies; primary care programs are not used comprehensively. This disparity reflects a major problem in health care delivery, setting the stage for errors or omission or commission which compromise optimal health outcome. Systematic understanding of the determinants of these usage styles which professionals consider inappropriate, based on consumer perspectives of their needs and priorities, is likely to suggest strategies for making primary care programs more responsive to their users.

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