Question: Are there any studies which can give parents some insight on how to avoid hospitalization for their children and reduce the number of admissions? Hospitals are sometimes dangerous places where infections are caught and where medical errors are more likely to occur. I would like to avoid these potential risks.
Whenever I am asked to assist in the teaching of pediatric residents and medical students in a hospital setting, the kind of admissions encountered causes the same question to be raised time and time again: “What could have been done differently to avoid this costly way of managing illnesses?”
An answer to this question remains elusive because of the complexity of each illness and, above all, because the terminology, “avoidable hospitalization” means different things to different people.
In an attempt to answer this question, parents, primary care physicians, and inpatient care physicians were surveyed in a useful study from Boston University (published in the November 2003 issue of Pediatrics). The purpose of the study was to find out if children could have been kept out of hospital. Participants in the study were surveyed over a 14-month period and were asked if 554 hospitalized children (with a median age of 4 years) could have been spared a hospital admission.
Six specific Avoidable Hospitalization Conditions (AHCs) were studied:
- Asthma
- Dehydration/gastroenteritis
- Pneumonia
- Skin infections
- Seizure disorders
- Urinary tract infections
The proportion of AHCs assessed as avoidable varied from 13% to 46%, depending on the source. Adolescents, children with asthma, children from working-poor families, and uninsured children were found to be at greatest risk for avoidable hospitalizations. The authors of the study concluded that many pediatric hospitalizations may be avoided if parents and children are better educated about the child’s condition, medications, the need for follow-up care, and the importance of avoiding known disease triggers.
The Boston study was not the first of its kind. Factors that have been found to be associated with avoidable hospitalizations in previous studies include:
- Poor access to care
- Poverty
- Low educational attainment
- Lack of health insurance
- Lack of a primary care physician
The majority of studies originated in US settings, but it is possible that the current challenge for Canadians to find primary care physicians may become a major reason for unnecessary admissions.
On a positive note, parents and physicians have consistently identified several factors that may prevent pediatric hospitalizations:
- Parents can pay close attention to their children’s medication-related issues (cited as the single most common reason for children being hospitalized); and doctors and parents can partner together to ensure that there is better medication adherence (including instruction on proper dosages, dose frequency, on treatment duration and how to obtain refills efficiently).
- Triggers can be clearly identified (such as cigarette smoke, pet allergens, dust and infections).
- Parents can request that their physician thoroughly educate them about their child’s condition, including the clinical course and the optimal preventive and treatment measures, so that adequate preventive measures can be taken.
- When follow-up visits for a child’s condition are delayed or don’t exist, the child is more likely to end up in hospital. Thus, it would be helpful if timely, effective outpatient care were created to prevent common Avoidable Hospitalization Conditions. It has been shown that patients who need follow-up visits do better when they can easily obtain those appointments.
When a child does end up in hospital, it is wise to ensure that intravenous treatment is adequate, that the child is not prematurely discharged, that a referral to a specialist is in place (when needed), and that there are definite written plans for follow-up in the parent’s hands prior to discharge.
To summarize, it will make a difference to educate families appropriately in three areas:
- Their child’s medical condition (I recommend using web sites i.e. asthmatics may benefit from (www.calgaryhealthregion.ca/ican).
- Their child’s medication (some pharmacies have greatly improved their patient education resources).
- The patient’s follow-up plans and resources in the community (consistency of care, as opposed to seeing various doctors who sometimes contradict themselves, should be the top priority).
The good news, for parents interested in further education and information, is that the Canadian Pediatric Society (www.caringforkids.cps.ca), recently announced that it will be sending frequent e-mail reminders to its website visitors. I have done the same for the past 6-months on my own web site.
I’ve created this website (www.healthykids.ca - this site requires registration, using a coupon code, entitled: “Herald”), and shared these studies with you because I believe that an educated parent is an empowered parent; and, these studies confirm that patient education pays off.
Dr. Peter Nieman is a parent of four children and hosts www.healthykids.ca. He teaches at the Alberta Children’s Hospital and is a member of the Canadian Pediatric Society and the American Academy of Pediatrics.
Access www.healthykids.ca for a terrific new resource in helping families raise healthy children - HealthyKids with Dr. Nieman will optimize your child's complete health.
An informed parent is ... an empowered parent.