Impact of the COVID-19 Pandemic on Emergency Department Encounters in a Major Metropolitan Area.

BACKGROUND: The end of 2019 marked the emergence of the COVID-19 pandemic. Public avoidance of health care facilities, including the emergency department (ED), has been noted during prior pandemics. OBJECTIVE: This study described pandemic-related changes in adult and pediatric ED presentations, acuity, and hospitalization rates during the pandemic in a major metropolitan area. METHODS: The study was a cross-sectional analysis of ED visits occurring before and during the pandemic. Sites collected daily ED patient census; monthly ED patient acuity, as the Emergency Severity Index (ESI) score; and disposition. Prepandemic ED visits occurring from January 1, 2019 through December 31, 2019 were compared with ED visits occurring during the pandemic from January 1, 2020 through March 31, 2021. The change in prepandemic and pandemic ED volume was found using 7-day moving average of proportions. RESULTS: The study enrolled 83.8% of the total ED encounters. Pandemic adult and pediatric visit volume decreased to as low as 44.7% (95% CI 43.1-46.3%; p < 0.001) and 22.1% (95% CI 19.3-26.0%; p < 0.001), respectively, of prepandemic volumes. There was also a relative increase in adult and pediatric acuity (ESI level 1-3) and the admission percentage for adult (20.3% vs. 22.9%; p < 0.01) and pediatric (5.1% vs. 5.6%; p < 0.01) populations. CONCLUSIONS: Total adult and pediatric encounters were reduced significantly across a major metropolitan area. Patient acuity and hospitalization rates were relatively increased. The development of strategies for predicting ED avoidance will be important in future pandemics.

Evaluating the Effect of Reach Out and Read on Clinic Values, Attitudes, and Knowledge.

OBJECTIVE: Reach Out and Read is a primary care clinic-based early childhood literacy promotion program that facilitates discussion around literacy and encourages shared reading at home. No prior studies have examined the effect of program implementation on clinic staff and clinic values, attitudes, and knowledge related to early literacy. The hypothesis of this study was that Reach Out and Read implementation not only improves early childhood literacy promotion, but also improves aspects of the clinician's work environment. Understanding the potential effects of this program on clinic staff is important, since many clinics will implement this program in the near future. METHODS: Semistructured key informant interviews were performed with 10 study clinics with Reach Out and Read and 7 control clinics. Interviews were transcribed, coded, and analyzed according to standard qualitative research protocol. Comparisons were made for differences in clinic morale and attitudes towards early childhood literacy. A secondary analysis examined practice and workplace changes in study clinics. RESULTS: The coded transcripts showed that clinicians at the majority of the study clinics believed that the program boosted clinic morale, increased provider satisfaction, improved patient-clinician relationships, and promoted a literacy-rich environment. Compared to clinicians in control clinics, clinicians in study clinics were more likely to report that they played a large role in promoting literacy and reported having more consistent literacy discussion in visits. Funding was the only concern mentioned consistently by clinics with Reach Out and Read. CONCLUSION: Understanding potential changes that can occur in clinics because of the Reach Out and Read program is crucial to help clinics adequately prepare for the implementation process. Knowing that this program has many advantages and few disadvantages in clinics may encourage more participation. Further studies should compare clinics with Reach Out and Read to those with no interest in the program to determine if results from this study can be more broadly generalized.

Access to Medicare-funded annual comprehensive health assessments for rural people with intellectual disability.

INTRODUCTION: People with intellectual disability (ID) comprise 2-3% of the Australian population. They mostly rely on their GP for primary health care. In rural areas where there are issues with health workforce shortages, there is a risk that people with ID may not get timely access to primary care or may not be aware of the range of healthcare services available to support them. Internationally, research has shown that regular health assessments are beneficial for people with ID. Annual comprehensive health assessments (ACHAs) have been shown to result in increased detection of medical conditions and could assist in reducing the gap in mortality between people with ID and the broader population. In Australia, people with ID have been eligible to access ACHAs under Medicare since 2007. These provide for a regular review of the person's physical, psychological and social functioning. This study explored the extent to which rural people with ID were accessing these ACHAs, and factors which affected their access to ACHAs. METHODS: In this qualitative study in-depth interviews were conducted with 18 participants including people with ID, carers/support workers and rural doctors. Interviews were then coded and analysed for themes. RESULTS: Seven themes were identified: (1) healthcare barriers in rural areas; (2) cohesion of rural communities; (3) the way rural doctors practice; (4) lack of knowledge/understanding; (5) venturing into new territory; (6) the role of the practice nurse; and (7) the health communication triangle. CONCLUSION: Despite the well-known problems of lack of services and distance to specialists in rural Australia, there are compensatory factors which were perceived as improving the wellbeing of people with ID, such as increased social cohesion and community connectedness. More education is needed to ensure that the rationale for ACHAs for people with ID is understood and that doctors feel confident to use them. The number of Medicare reforms implemented in a relatively short period presented change-management challenges for rural practices with rural workforce pressures. The role of the carer/support worker is crucial in the health assessment process and can improve the transfer of information about a client with ID between the disability and health sectors and within the health sector.