Chartbook on Healthy Living

• Children and adolescents whose health provider usually asks about prescription medications and treatments from other doctors.
• Emergency department (ED) visits with a principal diagnosis related to mental health, alcohol, or substance abuse.
• ED visits for asthma.

Communication About Prescription Medications and Treatments From Other Doctors

• Children are at risk for medication errors, including those due to polypharmacy, for several reasons:
  • Their size and physiologic variability.
  • Limited communication ability and other factors.²⁶
• Good medical practice includes asking patients about all their medications,²⁷ which can prevent adverse events.
• Patients are urged by the Food and Drug Administration and others to tell health care providers about all their medications.²⁸
• Health care systems are trying strategies to better communicate with patients about medications other health care professionals give them.²⁹

Providers Asking About Prescription Medications and Treatments From Other Doctors

Children and adolescents ages 0-17 years with a usual source of care whose health provider usually asks about prescription medications and treatments from other doctors, by race/ethnicity and income, 2012

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2012.

Note: White and Black are non-Hispanic. Hispanic includes all races.

• Trends: From 2002 to 2012, the percentage of children and adolescents whose health provider usually asked about medications and treatments from other doctors increased significantly, from 71.1% to 79.5% (data not shown).
• Groups With Disparities:
  • In 2012, there were no statistically significant differences between Whites (79.5%), Blacks (80.9%), and Hispanics (79.8%) in the percentage of children whose health provider asked about medications and treatments from other doctors.
  • In 2012, there were no statistically significant differences by income:
    • Poor, 77.4%.
    • Low income, 80.2%.
    • Middle income, 81.1%.
    • High income, 79.1%.

Emergency Department Visits Related to Mental Health and Substance Abuse

• EDs are a common source of care for mental illness when high-quality mental health care is not available in the community.³⁰
• Some ED use for mental health and substance abuse problems among young people is seen as preventable with appropriate ambulatory care.
• Mental, emotional, and behavioral health services are lacking for as many as 50 percent of children and adolescents with high needs.³¹
• EDs are often not staffed or equipped to provide optimal psychiatric care, leading to long wait times for appropriate care.³²
• ED staff observing patients waiting for psychiatric care find it difficult to efficiently care for patients with other medical emergencies.³³
• Efforts are underway to prevent avoidable ED use through strategies such as case management.^34,35

Emergency Department Visits With a Principal Diagnosis Related to Mental Health, Alcohol, or Substance Abuse

Emergency department visits with a principal diagnosis related to mental health, alcohol, or substance abuse among children ages 0-17 years, per 100,000 population, 2007-2011

Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, State Inpatient Databases and AHRQ Quality Indicators, modified version of 4.1.

• Overall: In 2011, among children ages 0-17 years, there were 697.5 ED visits related to mental health, alcohol, or substance use per 100,000 population.
• Trends: There were no statistically significant changes in ED visit rates for children related to mental health, alcohol, or substance use between 2007 (621.8 per 100,000 population) and 2011 (697.5 per 100,000 population).

Emergency Department Visits for Asthma

• Asthma is a common chronic disease among children.³⁶
• ED visits for asthma are often preventable if a child receives high-quality ambulatory preventive and acute care.
• A recent review shows three strategies were most likely to improve provider adherence to asthma guidelines, which indicates high-quality care:
  • Decision support tools.
  • Feedback and audit.
  • Clinical pharmacy support.³⁷

Emergency Department Visits for Asthma

Emergency department visits for asthma per 100,000 population, children ages 2-17 years, by age, 2008-2011, and by sex and income quartile of ZIP code of residence, 2011

Left Chart:

Right Chart (visits per 100,000 population):

• Male - 1112.8.
• Female - 743.6.
• Q1—Lowest - 1254.5.
• Q2 - 990.6.
• Q3 - 851.
• Q4—Highest - 621.2.

Key: Q = quartile.
Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, State Inpatient Databases and AHRQ Quality Indicators, modified version of 4.1.

• Overall Rate: Emergency department utilization rates for asthma are lower for children ages 15-17 than for children in younger age groups.
• Trends: From 2008 to 2011, among children ages 2-17 years, there were no statistically significant changes in ED visit rates for asthma (851.9 per 100,000 population vs. 932.1; data not shown).
• Groups With Disparities:
  • In 2011, male children ages 2-17 were 1.5 times as likely as female children to experience an ED visit for asthma (1,112.8 per 100,000 population vs. 743.6).
  • Also in 2011, children whose ZIP code of residence was in the highest income quartile were less likely than children in the first (lowest), second, and third quartiles to have an ED visit for asthma (621.2 per 100,000 population vs. 1,254.5, 990.6, and 851.0, respectively.

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