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Emergency Health Care Use among Sociodemographic Groups of Children Presenting to Emergency Departments for Self-Harm in Alberta

  • Amanda S. Newton (a1) (a2), Conrad I. Tsang (a3) and Rhonda J. Rosychuk (a1) (a2)

Abstract

Objective

To examine sociodemographic variations among children <18 years in (1) rates of self-harm visits to emergency departments (EDs) and (2) physician follow-up after the self-harm visit in Alberta.

Methods

A retrospective, population-based cohort (2002–2011) of ED visits for self-harm by individuals <18 years was conducted using administrative databases from Alberta, Canada. Individuals were grouped by First Nations status or type of health care premium subsidy (family receipt of government subsidy, human services program subsidy, no subsidy received). Visits from 104 EDs were summarized by crude and directly standardized visit rates (DSVRs) per 100,000 individuals. Kaplan-Meier estimates for median estimated time to physician follow-up were calculated with 95% confidence intervals (CIs).

Results

During the study period, visit rates decreased with the exception of children from families receiving government-sponsored program subsidy (DSVRs 163/100,000 to 250/100,000; p=0.032). First Nations children had disproportionately fewer follow-up visits compared to other children. The median time to follow-up for First Nations children was 39 days (95% CI: 32, 48) compared to 16 days for children from families receiving no subsidy (95% CI: 14, 19), who had the shortest follow-up time after an ED visit.

Conclusions

Sociodemographic differences were evident in ED visit rates as well as the number of and time to physician follow-up visit. The disparities experienced by First Nations children in the follow-up period highlight an opportunity for culturally-grounded risk and needs assessment in the ED to determine and facilitate timely and appropriate follow-up care.

Objectifs

L’étude visait à examiner les écarts sociodémographiques chez les enfants <18 ans, qui s’étaient infligés de l’automutilation, en ce qui concerne: 1) les taux de consultation aux services des urgences (SU); 2) les taux de suivi médical après ces consultations, en Alberta.

Méthode

Il s’agit d’une étude rétrospective, de cohortes fondées sur la population (2002–2011) et menée chez des jeunes <18 ans, traités dans des SU pour de l’automutilation, à l’aide de bases de données administratives, en Alberta, au Canada. Les jeunes ont été divisés selon le statut de membre des Premières Nations ou selon le type de subvention versée pour des soins de santé (subvention publique aux familles, subvention de services à la personne, aucune subvention). Les consultations faites dans 104 SU sont exprimées en taux bruts et en taux directement normalisés de consultations (TDNC) pour 100 000 personnes. L’estimation du temps d’attente médian avant les consultations médicales de suivi a été calculée selon la méthode de Kaplan-Meyer, à l’aide d’intervalles de confiance (IC) à 95 %.

Résultats

Durant la période à l’étude, les taux de consultation ont diminué, à l’exception de celles faites chez les enfants de familles bénéficiaires de subventions publiques (TDNC: 163/100 000 à 250/100 000; p=0,032). Les taux de suivi chez les enfants des Premières Nations étaient particulièrement bas, hors de proportion avec ceux enregistrés chez les autres enfants. Ainsi, le temps d’attente médian avant les consultations de suivi chez les enfants des Premières Nations était de 39 jours (IC à 95 %: 32–48) contre 16 jours chez les enfants de familles non bénéficiaires de subvention (IC à 95 %: 14–19); ces derniers avaient d’ailleurs les délais d’attente les plus courts pour un suivi après une consultation dans un SU.

Conclusions

Il ressort de l’étude des écarts sociodémographiphes très nets en ce qui concerne les taux de consultation au SU ainsi que le nombre de consultations médicales de suivi et le temps d’attente avant celles-ci. Les disparités que connaissent les enfants des Premières Nations quant à la période de suivi offrent une belle occasion de procéder, au SU, à une évaluation, fondée sur la culture, des risques et des besoins, en vue de la détermination des soins de suivi appropriés et de leur prestation rapide.

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Copyright

Corresponding author

Correspondence to: Dr. Amanda Newton, PhD, Department of Pediatrics, Faculty of Medicine & Dentistry, Room 3-526, Edmonton Clinic Health Academy, 11405 - 87 Avenue NW, Edmonton, Alberta T6G 1C9; Email: mandi.newton@ualberta.ca

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