The American Academy of Pediatrics today revised its policy statement on “the expanding models of acute care services.” Translation: that’s all the walk-in clinics, urgent care facilities, stand alone emergency rooms that have popped up. The statement “Nonemergency Acute Care: When It’s Not the Medical Home,” will be published in the May issue of Pediatrics.
It states that “the ideal location for children to receive care for acute, nonemergency health concerns is at a pediatrician’s office or similar “medical home” that offers continuous, comprehensive and coordinated care.”
And of course, the policy statement acknowledges that there are some benefits of those alternatives to the pediatrician’s office: mainly convenience and accessibility.
At the core, is the academies concern about coordinated care. If you’re going to one clinic one day, another clinic another day and your pediatrician’s office the next, does your pediatrician have enough information to put together the whole picture?
“Children deserve to receive care from a skilled professional, a physician who knows their needs and medical history, who works alongside family members to keep them safe and healthy,” said Susan Kressly, MD, a lead author of the policy statement, in a press release.
“While families may sometimes feel the need to seek medical care at retail centers or elsewhere outside the doctor’s office, we remain concerned that the treatment delivered at many of those facilities falls short of evidence-based medical standards.”
The statement recommends that clinics treating children should do these things:Maximize continuity of care by rapidly communicating information and referring the child for necessary follow-up to the medical home. Provide care that is based on the best available evidence and have clearly defined limits of scope of service that are transparent to families. Ensure that the staff have pediatric training and experience. Establish protocols for in-person and technology-enabled care for transitions of care during emergencies, during situations outside scope of care, and for after-hours coverage. Put in place strategies for continuous assessment and improvement for quality of care and patient safety.
The statement makes some very clear recommendations for parents and their doctor’s offices:Children younger than 2 should not be treated at clinics that do not have pediatric expertise. Pediatric offices need to expand their offerings to families, such as expanded hours. Children with chronic illnesses, complex conditions, including behavioral health, should be seen by their doctor’s offices. Well-checks, including vaccinations and physical examinations, should be done in the doctor’s offices.
If you’re in the market for a pediatrician or a new pediatrician, that expanded office hours picture should be one of the first questions on your list. How available are sick appointments? What are the nurse’s line hours? If there is extended office hours or urgent care, what are those hours and how available are those appointments? What happens if your child is sick in the middle of the night?
That doctor might be the BEST DOCTOR EVER, but if you can’t get in to see that doctor when you need to or at least someone in the practice who will have access to all your records and then share reports with your doctor, that might not be the doctor for you. After all, when do we need doctor’s the most? It’s probably not 9 a.m. to 5 p.m. Monday through Friday. Right?