Publicly Insured Pediatric Patients Increasingly Receiving Psychiatric Care in EDs, Study Finds

   That emergency departments are increasingly serving as a safety net for patients with limited outpatient resources and other access to care is a known. What's less well known is that pediatric patients, either without insurance or receiving Medicaid, are increasingly receiving psychiatric care in EDs.

   Zachary E. Pittsenbarger, MD, and Rebekah Mannix, MD, MPH, of the Department of Emergency Medicine at Children's Hospital in Boston, presented the results of their study at the American Academy of Pediatrics National Conference and Exhibition, also in Boston.

   They reviewed ED data, including patient age, gender, race, ethnicity, insurance status, and type of care received, from the National Hospital Ambulatory Medical Care Survey, between 1999 through 2007. The study, "Disproportionately Increasing Psychiatric Visits to the Pediatric Emergency Department Among the Underinsured," found that over eight years, 279 million pediatric patients were seen in American EDs, of which 2.8% were for psychiatric visits. The prevalence of psychiatric visits among pediatric patients increased from 2.4% in 1999 to 3% in 2007 (P=0.03 for trend). The underinsured group initially accounted for 46% of pediatric ED visits in 1999, growing to 54% in 2007 (P=0.03 for trend).

   The results of this study are important for several reasons, the researchers said. First, the data show that, as anticipated, psychiatric visits by children to emergency departments continue to increase in number and as a percentage of all patients being seen in EDs, said Dr. Pittsenbarger, the lead author. "A second, and more novel finding, is that one group in particular is increasing beyond any other socio-demographic group, and that is the publicly insured."

   "It has been found previously that the publicly insured have fewer treatment options and longer wait times for psychiatric disorders when not hospitalized," He added. "This new finding argues that limited outpatient mental health resources force those patients to seek the care they need in the emergency department."