Redirecting patients from the pediatric emergency department to community locations for care: A qualitative study of healthcare professional and leader perspectives

by Erica Qureshi, Quynh Doan, Jessica Moe, Steven P. Miller, Garth Meckler, Brett Burstein, Jehannine (J9) Austin

Objectives

Emergency department (ED) to community (ED2C) programs, which redirect patients from the pediatric ED to community healthcare professionals represent a promising strategy to reduce the impact of non-urgent visits on the pediatric ED. Given an ED2C program’s potential impact on various care professionals, we completed a qualitative study to explore key informants’ attitudes and perceptions of pediatric ED2C programs.

Methods

We conducted one-on-one semi-structured interviews with key informants in British Columbia, Canada. Participants included: pediatric ED staff – triage nurses and physicians; community professionals – pediatricians and family physicians; and health system leaders responsible for pediatric and emergency care in British Columbia. Interviews were recorded, transcribed verbatim, de-identified, and analyzed using reflexive thematic analysis within an interpretive description framework. A visual model was developed to depict key themes in attitudes and perceptions towards pediatric ED2C programs.

Results

We interviewed 24 participants: 6 community professionals, 11 pediatric ED professionals, and 7 healthcare leaders. Participants viewed the ED2C program as a valuable solution to address pediatric system strain provided that systemic barriers are addressed, and both emergency and community settings are equipped with adequate training and resources. Participants emphasized the need for clear guidelines on eligibility and operations to build confidence and enhance program effectiveness.

Conclusions

Our findings suggest there is support for ED2C programs as a means to reduce the impact of non-urgent pediatric ED visits and strengthen community-based care. Successful implementation will require coordinated planning, resource investment, and clear operational frameworks.

Randomized crossover trial of hand and hydrostatic casting for custom lower limb prosthetic sockets: Assessing socket comfort and fabrication time

by Stefania Fatone, Amy Gravely, Andrea Giovanni Cutti, Andrew H. Hansen, Steven A. Gard, on behalf of the Residual Limb Shape Capture Group

The aim of this study was to compare diagnostic sockets made by hand casting and standing hydrostatic pressure casting in persons with lower limb amputation. This multi-site, single-masked, randomized crossover trial (ClinicalTrials.gov NCT04141748) involved a prosthetist at each site taking one cast by hand (H) and another using hydrostatic casting (S). The process of casting, rectifying and modifying a diagnostic socket was timed in minutes. Socket comfort score (SCS) was assessed during static fitting of the diagnostic socket before (initial) and after (final) any modifications were made by the prosthetist. Difference scores for comfort and timing were calculated for each pair of casts within prosthetist. Bootstrapping methods were used to determine if the mean difference scores were significantly different from zero. Eighty participants with unilateral lower limb amputation were enrolled, with 75 completing the study. The initial SCS was significantly better in the transfemoral amputation group (TFA, n = 24) for the socket made from hand casting (H: 7.1 ± 1.9, S: 6.5 ± 2.2; p = 0.043). The final SCS was significantly better in the transtibial amputation group (TTA, n = 51) for the socket made from hydrostatic casting (H: 7.5 ± 2.0, S: 8.1 ± 1.3; p = 0.025). Total fabrication time for hydrostatic casting was significantly greater than hand casting (H: 42.1 ± 15.6, S: 48.0 ± 10.7; p = 0.001). It took significantly more time to cast (H: 10.6 ± 5.5, S: 23.7 ± 6.1; p 

The dynamic of treatment-seeking in a community sample with obsessive-compulsive symptoms: A mixed method approach

by Winitra Kaewpila, Thanavadee Prachasan, Ratana Saipanish, Thanita Tantrarungroj, Fred Stevens

Objective

This mixed-method study aimed to investigate factors associated with treatment-seeking behaviors in people with obsessive-compulsive (OC) symptoms in the community and explore their experiences along the dynamic of treatment-seeking processes.

Method

Eighty-one subjects with OC symptoms (27 treatment seekers and 54 non-seekers) completed online questionnaires about treatment history, symptom severity, and factors influencing treatment-seeking. The characteristics of treatment seekers and non-seekers were compared using Pearson’s Chi-square and independent T-tests. Qualitative data were derived from a subset of 26 participants undergoing a follow-up telephone interview and subsequently analyzed by thematic analysis.

Results

Treatment seeking was associated with more severe overall OC and obsessive symptoms and more feeling out of control over the symptoms (p  Conclusion

The symptom severity and feeling out of control are critical factors associated with treatment-seeking among people with OC symptoms in the community. Enhancing the feeling of control could be pivotal in promoting help-seeking behaviors in this population.