• Astha Singhal, Daniel J Caplan, Michael P Jones, Raymond A Kuthy, Elizabeth T Momany, Christopher T Buresh, and Peter C Damiano.
• Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, Iowa, USA Public Policy Center, University of Iowa, Iowa City, Iowa, USA.
• Emerg Med J. 2016 May 1; 33 (5): 313-8.

ObjectivesTo identify the factors associated with paediatric emergency department (ED) visits and parental perceptions of the avoidability of their child's ED visit.DesignCross-sectional study by performing secondary analysis of 2010-2011 Iowa Child and Family Household Health Survey data.SettingState-wide representative population-based sample of families with at least one child in the state of Iowa in the USA.Patients/ParticipantsAmong the eligible households, 2386 families completed the survey, yielding a cooperation rate of 80%.Exposure/InterventionPresence of a medical home.Main Outcome MeasuresChild visiting an ED in the past year; parents believing that ED care could have been provided in a primary-care setting.ResultsAmong children who needed medical care in the past year, 26% visited an ED. Younger children, non-Hispanic black children, non-Hispanic others, children whose parents were not married, children who were from food-insecure households and had poorer health status were more likely to visit an ED. Having a medical home was not associated with ED visits (OR=0.80, 95% CI 0.61 to 1.04), even after stratifying by the child's health status. About 69% of parents who took their child to an ED agreed that ED care could have been provided in a primary-care setting. Parents of children with public insurance, those who were not referred to the ED and those who could not get routine care appointments were more likely to report a primary-care preventable ED visit.ConclusionsThe majority of parents believed that paediatric ED visits could be avoided if adequate primary-care alternatives were available. Expanding access to primary care could lead to a reduction in avoidable ED visits by children.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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