Continuity of Care – Pediatric Urgent Care and Primary Care Pediatrician

Parents' first reaction to the appearance of a new clinic in their area that provides "after hours" urgent care for children and thus an alternative to inconvenient (and often very expensive) visits to the nearest Emergency Room is usually one of relief. "Finally," they say. "Why didn't anyone think of this sooner?"

But the addition of after hours care for children to your community offers more than just convenience and lower health care costs. It also provides the opportunity for improved continuity of care that can provide a more comprehensive approach to children's health care. In this article we'll talk a bit about some of the advantages of Pediatric Urgent Care centers other than the obvious ones.

The 'Medical Home' and the 'Medical Neighborhood'

The optimal setting for comprehensive health care for children has been called by the American Academy of Pediatrics (AAP) the Medical Home. This term refers to Pediatric Primary Care practices that address acute but nonemergency health concerns. According to the AAP, the goal of the Medical Home is "to provide comprehensive, continuous, coordinated, compassionate, and culturally effective care for infants, children, and adolescents, maximizing clinical outcomes that support long-term health while also providing family-centered care.‍"

These Pediatric Primary Care practices and the highly-trained doctors and nurses who staff them do a wonderful job of providing quality medical care to their young patients. But there are limitations as to when they can provide these services. Pediatricians are people, too, and they have lives outside their jobs, just like everyone else. So they need their evenings and weekends "off work," just like everyone else. Unfortunately, because children don't get sick according to their regular Pediatricians' schedules, this has meant that kids who need "after hours" care often had to be taken to an Emergency Room.

Recently, the idea of the Medical Home has been extended to include a new type of care, Pediatric Urgent Care centers. These clinics, staffed by equally highly-trained Pediatricians and nurses, focus on providing care for non-life-threatening illnesses or injuries during the Primary clinics' "off hours." Urgent Care clinics are open after normal working hours, at night, and on weekends.

In a very real sense, these kids' Urgent Care clinics "fill in the gaps" to provide a more comprehensive approach to children's health care. They work outside, but in coordination with the Medical Home, creating a more comprehensive care system that has been called the Medical Neighborhood. This extended approach has been defined by the AAP as " a clinical-community partnership that includes the medical and social supports necessary to enhance health, with the [medical home] serving as the patient’s primary ‘hub’ and coordinator of health care delivery.”

"Welcome to the neighborhood" – How Urgent Care improves overall kids' care

The addition of a Pediatric Urgent Care center to your local health care "neighborhood" provides the opportunity for greater communication between Primary Care providers and Urgent Care providers. When parents have to rely only on the local Emergency Room to handle their after-hours needs, information can get lost in the process. The ER doesn't necessarily know anything about the medical history of the young patients it treats, because their records are located only at the Pediatric Primary Care center that normally treats them. Conversely, after late-night or weekend treatment at an ER, critical information does not always get back to the child's Primary caregivers.

Many of the new Pediatric Urgent Care clinics have close relationships with the Pediatric Primary Care clinics in their area. This allows opportunities for improved communication such as:

  • Urgent Care facilities can make arrangements to share medical data with their patients' Primary Care facilities. This ensures that the child's regular Pediatrician is always aware of any medication or procedure that was prescribed elsewhere.
  • Conversely, some Primary Care clinics have taken a "proactive" approach to their young patients' health care by "pre-sharing" the records of kids who might be likely to require after hours care. For example, if the child has asthma and is prone to attacks, the local Urgent Care center can be sent the child's records to make sure they are aware of his or her medical history, current medications, etc.
  • With improved communication, critical medical test results performed in an Urgent Care treatment center can reliably be made available to the patients' Primary Care providers, and vice-versa.
  • The addition of an Urgent Care facility to Primary Care facilities also opens the possibility of co-management or joint care treatment of Pediatric conditions that require long-term treatment.

In conclusion, almost everyone involved with Pediatric care agrees that the ideal place for treatment of children may be the Medical Home. But practical concerns often make that impossible on a 24/7 basis. So Pediatric Urgent Care should be viewed as a valuable extension to the primary care system, and a very welcome new member of the neighborhood.


References

American Academy of Pediatrics, "Medical Home Initiatives for Children with Special Needs Project Advisory Committee. The medical home." Pediatrics. 2002;110(1 pt 1):184–186

Conners GP, Kressly SJ, Perrin JM, et al (American Academy of Pediatrics). "Nonemergency Acute Care: When It's Not the Medical Home". Pediatrics 2017; 139(5):e20170629.

American Academy of Pediatrics. "Pediatric Care Recommendations for Freestanding Urgent Care Facilities". Pediatrics 2014; 133:950-953. http://www.pediatrics.org/cgi/doi/10.1542/peds.2014-0569.

WebMD. "Shopping for a Pediatrician" https://www.webmd.com/baby/shopping-for-a-pediatrician#1. Accessed on October 20, 2017.

Source: Urgent Care for Children

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