Understanding Factors that Influence Pregnant and Parenting Teenagers to Seek Medical Care for Themselves and Their Children in the Emergency Room versus with their Primary Care Providers

Abstract

Background: Overuse of emergency rooms (ER) is an important topic in light of increasing health care costs and decreasing numbers of primary care providers (PCPs). Frequent ER visits were noted to be an issue by the directors of the Teen Living Program (TLP), a non-profit residential shelter for pregnant and parenting teenagers in Worcester, MA. However, there have been very few studies that examine the factors that influence patients to visit the emergency room, and none of the studies identified were focused on adolescents or adolescent parents. Objectives: This study aims to address this gap in literature related to use of the ER by adolescent females who are pregnant or already parenting a child. Specifically, this study was designed to explore the social, emotional, and economic factors that influence how teens at TLP utilize the medical system in order to ultimately help them strengthen relationships with healthcare providers and assist the healthcare system with better serving them. Methods: This was a qualitative study utilizing focus groups and a demographic questionnaire as our data collection methods. Two focus groups were conducted using a semi-structured interview guide and were held during group sessions at TLP. There were 10 participants aged 17 to 21 years, each of whom were mothers with one child; none were pregnant at the time. The focus groups were audio-recorded and lasted 1.5 hours, with an additional 15 minutes at the conclusion for the questionnaire. Digital recordings of the groups were transcribed verbatim. For analysis, textual data was categorized into major themes and subthemes, and representative quotes were selected. Results: The participants’ choice of medical care was predominantly related to previous personal negative experiences and positive relationships. Negative experiences included fear of bad news, dislike of back-up doctors as opposed to their regular PCP, and providers who don’t spend enough time with patients or respect their concerns. Positive experiences were centered around trust, specifically knowing the patient by name, remembering personal details and spending time with them. Experiences and stories from family and friends also played a role in trust and decision-making. Financial considerations were related mainly to transportation options, as opposed to the cost of the care, tests or prescriptions, because of comprehensive insurance coverage. Conclusion: The choice of where to seek medical care can be confusing for adolescents, particularly young mothers who are in the “twilight zone” between adolescence and adulthood. Attention needs to be directed toward developing tools to explain the process of contacting a PCP and going to the ER, as well as improving trust between patients and PCPs.