Caregiver Low Health Literacy and Nonurgent Use of the Pediatric Emergency Department for Febrile Illness |
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| Affiliation: | 1. Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wis;2. Medical College of Wisconsin, Milwaukee, Wis;3. Department of Medicine, University of Pennsylvania, Philadelphia, Pa;4. Children''s Hospital of Wisconsin, Milwaukee, Wis;5. Quantitative Health Sciences/Biostatistics, Milwaukee, Wis;1. Smithsonian Astrophysical Observatory, 60 Garden St. Cambridge, MA 02138, United States;2. Space Telescope Science Institute, 3700 San Martin Dr. Baltimore, MD 21218, United States;3. Infrared Processing and Analysis Center, 770 South Wilson Ave. Pasadena, CA 91125, United States;4. National Optical Astronomy Observatory, 950 N Cherry Ave. Tucson, AZ 85719, United States;1. Division of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States;2. Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States;3. PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States;4. Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, United States;1. Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA;2. Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA;3. Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA;1. Division of Emergency Medicine, Department of Pediatrics, BC Children''s Hospital, Vancouver, British Columbia, Canada;2. Division of Child and Adolescent Psychiatry, Department of Psychiatry, BC Children''s Hospital, Vancouver, British Columbia, Canada |
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| Abstract: | ObjectiveTo examine the association between caregiver health literacy and the likelihood of a nonurgent emergency department (ED) visit in children presenting for fever.MethodsThis cross-sectional study used the Newest Vital Sign to assess the health literacy of caregivers accompanying children with fever to the ED. Visit urgency was determined by resources utilized during the ED visit. Findings were stratified by race and child age. Chi-square and logistic regression analysis controlling for race were conducted to determine the association between low health literacy and ED visit urgency.ResultsA total of 299 caregivers completed study materials. Thirty-nine percent of ED visits for fever were nonurgent, and 63% of caregivers had low health literacy. Low health literacy was associated with a higher proportion of nonurgent ED visits for fever (44% vs 31%, odds ratio 1.8, 95% confidence interval [CI] 1.1, 2.9). Low health literacy was associated with higher odds of a nonurgent visit in white and Hispanic caregivers but not in black caregivers. In regression analysis, children ≥2 years old had higher odds of a nonurgent visit if caregivers had low health literacy (adjusted odds ratio 2.0; 95% CI 1.1, 4.1); this relationship did not hold for children <2 years old (adjusted odds ratio 0.8; 95% CI 0.4, 1.8).ConclusionsNearly two-thirds of caregivers with their child in the ED for fever have low health literacy. Caregiver low health literacy is associated with nonurgent ED utilization for fever in children over 2 years of age. Future interventions could target health literacy skills regarding fever in caregivers of children ≥2 years. |
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| Keywords: | child preschool emergency service hospital health literacy health services accessibility infant nonurgent emergency care use utilization |
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