TOPLINE:

Children without an identified primary care provider (PCP) had higher odds of healthcare visits occurring in the emergency department (ED).

METHODOLOGY:

• Researchers conducted a retrospective cross-sectional study using data from a nationally representative longitudinal survey that included 9878 children from 2021 to 2022.
• Primary care access was determined on the basis of affirmative responses to having a usual source of medical care.
• The primary outcomes were frequent ED utilization, defined as two or more ED visits annually based on previous patterns, and high reliance, calculated as the percentage of healthcare visits occurring in this setting.
• Among children with an identified source of primary care, researchers evaluated associations between specific components of PCP access, such as travel time, ease of contact, ease of contact after hours, and availability during nights and weekends.
• The surveyed children represented more than 72.5 million children nationally, with 83.2% having a PCP.

TAKEAWAY:

• Lack of PCP access was associated with a higher likelihood of high ED reliance (adjusted odds ratio [aOR], 1.78; P < .001) but was not significantly associated with frequent ED utilization.
• Children younger than 1 year (aOR, 3.91; P < .05) and those between ages 1 and 5 (aOR, 3.09; P < .001) were more likely to have frequent ED utilization than children aged 6-11 years.
• Hispanic children (aOR, 2.17; P < .001), Black children (aOR, 2.58; P < .001), and other/multiple race children (aOR, 1.76; P < .05) were more likely to have higher ED reliance than White children. Children with special healthcare needs had increased odds of frequent ED utilization (aOR, 3.65; P < .001) but not high ED reliance.
• Among children with identified PCPs, none of the examined access components showed significant associations with either frequent ED utilization or high ED reliance.

IN PRACTICE:

“[A]lthough having an identified PCP may help mediate ED reliance, its impact is not uniform across all pediatric populations and does not appear to reduce overall ED utilization. The strong and distinct associations found with sociodemographic factors highlight that systemic and social determinants of health are critical drivers of how and why children use the ED,” the authors wrote.

SOURCE:

This study was led by Lukas K. Gaffney, MD, MPH, of the Division of Emergency Medicine at Boston Children’s Hospital and Harvard Medical School in Boston. It was published online on June 7, 2026, in The Journal of Pediatrics.

LIMITATIONS:

The survey did not include specific clinical details, making it hard for researchers to know if ED visits could have been managed safely at other care locations.

DISCLOSURES:

The authors did not report any funding.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.