A tool to identify potential primary care presentations in the hospital emergency department

Abstract Background Access to primary care has an impact on health outcomes and is a significant public health issue. Limited access to primary care has seen non-urgent presentations to hospital emergency departments continue to rise globally. A lack of a universal workable definition of what a primary care presentation is has impeded national and international estimations of the true burden. Our aim was to develop a standardised code frame to identify potential primary care patients in the emergency department to allow accurate data estimations to be made, and help inform future interventions. Methods An audit of medical records was conducted in two major hospitals in Sydney, Australia. A code frame was developed, tested and applied retrospectively to five years of data. Results Of 601,168 presentations to the emergency department, 171,906 (29%) were deemed to be potential primary care presentations. The code frame had a sensitivity of 99.9% and a specificity of 49.0%. Conclusions This standardised code frame enables accurate retrospective local and national data estimations of the impact of primary care presentations in the emergency department, which was previously not available. The code frame could be used prospectively to evaluate interventions such as diverting patients to primary care settings, and to identify populations for specifically targeted interventions. The conservative nature of the code frame ensures that only those that can safely receive care in a primary care setting are identified as potential primary care. Key messages This robust tool will enable more accurate data estimations of primary care appropriate presentations in the emergency department, which can assist planning and policy efforts. It can be easily adapted to incorporate triage codes in international settings and provides a useful tool for comparing international trends.

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Greater access to primary care may reduce emergency department use

PsycEXTRA Dataset ◽

10.1037/e556202006-026 ◽

2005 ◽

Keyword(s):

Primary Care ◽

Emergency Department ◽

Emergency Department Use ◽

Access To Primary Care

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Correction to: Measuring the impact of the Afordable Care Act Medicaid expansion on access to primary care using an interrupted time series approach

Health Research Policy and Systems ◽

10.1186/s12961-021-00740-y ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Elizabeth A. Brown ◽

Brandi M. White ◽

Walter J. Jones ◽

Mulugeta Gebregziabher ◽

Kit N. Simpson

Keyword(s):

Primary Care ◽

Time Series ◽

Interrupted Time Series ◽

Medicaid Expansion ◽

Time Series Approach ◽

Access To Primary Care ◽

The Impact

An amendment to this paper has been published and can be accessed via the original article.

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Geographical factors in access: investigating the impact of distance on the use of primary care extended hours, an administrative data study.

International Journal for Population Data Science ◽

10.23889/ijpds.v4i3.1245 ◽

2019 ◽

Vol 4 (3) ◽

Author(s):

Jen Murphy ◽

William Whittaker ◽

Mark Elliot ◽

Rathi Ravindrarajah

Keyword(s):

Primary Care ◽

Negative Binomial ◽

Unmet Need ◽

Negative Binomial Regression ◽

City Region ◽

Hub Location ◽

Barriers To Access ◽

Access To Primary Care ◽

The Right ◽

The Impact

IntroductionNHS national targets mandate extended opening hours of doctors’ surgeries as a mechanism for increasing access to primary care, based on the assumption that unmet need is caused by a lack of appointments at the right time. Research has shown that other factors impact access and it may not simply be availability that limits an individual’s ability to access healthcare. Aims and Objectives To determine whether distance, familiarity and deprivation impact on the uptake of extended hours GP services that use a hub practice model. MethodsWe linked an appointments dataset to publicly available population datasets. With that linked dataset, we used negative binomial regression to model count data relating to uses of the extended hours service in one care commissioning group in the Greater Manchester city region. The dataset included 32,693 appointments across 4 hubs serving 37 practices. ResultsFamiliarity and distance are important in predicting the number of uses of the extended hours service at a GP practice level. For a theoretical pair of practices collocated at the hub location, the model predicts a use rate of 101.2 for the non hub compared with 283.7 for the hub, a 180% uplift. For a pair of non-hub practices, one located the mean distance from the hub, the other located one mile further away, the model predicts 64.8 uses for the nearer practice, and 46.5 uses for the far practice, a 28% penalty. ConclusionThe results indicate geographical inequity in the extended hours service. There may be many patients with unmet need for whom the extension of hours via a hub model does not address barriers to access. Providers should consider whether or not this type of model actually works to facilitate access. This is particularly of importance in the context of closing health inequality gaps.

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The impact of primary care on emergency department presentation and hospital admission with pneumonia: a case–control study of preschool-aged children

npj Primary Care Respiratory Medicine ◽

10.1038/npjpcrm.2014.113 ◽

2015 ◽

Vol 25 (1) ◽

Cited By ~ 4

Author(s):

Diane P Emery ◽

Tania Milne ◽

Catherine A Gilchrist ◽

Megan J Gibbons ◽

Elizabeth Robinson ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Hospital Admission ◽

Case Control Study ◽

Case Control ◽

Emergency Department Presentation ◽

The Impact ◽

Control Study ◽

Preschool Aged Children

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The Value of Local Heatwave Impact Assessment: A Case-Crossover Analysis of Hospital Emergency Department Presentations in Tasmania, Australia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16193715 ◽

2019 ◽

Vol 16 (19) ◽

pp. 3715 ◽

Cited By ~ 3

Author(s):

Sharon L. Campbell ◽

Tomas A. Remenyi ◽

Grant J. Williamson ◽

Christopher J. White ◽

Fay H. Johnston

Keyword(s):

Emergency Department ◽

Capacity Planning ◽

Conditional Logistic Regression ◽

Hospital Emergency Department ◽

Hospital Emergency ◽

Case Crossover ◽

Crossover Analysis ◽

The Impact ◽

The Relationship ◽

Local Research

Heatwaves have been identified as a threat to human health, with this impact projected to rise in a warming climate. Gaps in local knowledge can potentially undermine appropriate policy and preparedness actions. Using a case-crossover methodology, we examined the impact of heatwave events on hospital emergency department (ED) presentations in the two most populous regions of Tasmania, Australia, from 2008–2016. Using conditional logistic regression, we analyzed the relationship between ED presentations and severe/extreme heatwaves for the whole population, specific demographics including age, gender and socio-economic advantage, and diagnostic conditions that are known to be impacted in high temperatures. ED presentations increased by 5% (OR 1.05, 95% CI 1.01–1.09) across the whole population, by 13% (OR 1.13, 95% CI 1.03–1.24) for children 15 years and under, and by 19% (OR 1.19, 95% CI 1.04–1.36) for children 5 years and under. A less precise association in the same direction was found for those over 65 years. For diagnostic subgroups, non-significant increases in ED presentations were observed for asthma, diabetes, hypertension, and atrial fibrillation. These findings may assist ED surge capacity planning and public health preparedness and response activities for heatwave events in Tasmania, highlighting the importance of using local research to inform local practice.

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Development and evaluation of a code frame to identify potential primary care presentations in the hospital emergency department

Emergency Medicine Australasia ◽

10.1111/1742-6723.13293 ◽

2019 ◽

Vol 31 (6) ◽

pp. 982-988 ◽

Cited By ~ 1

Author(s):

Heike Schütze ◽

Rhyannan Rees ◽

Stephen Asha ◽

Kathy Eagar

Keyword(s):

Primary Care ◽

Emergency Department ◽

Hospital Emergency Department ◽

Hospital Emergency

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Community-based aftercare following an emergency department presentation for attempted suicide or high risk for suicide: study protocol for a non-randomised controlled trial

BMC Public Health ◽

10.1186/s12889-019-7751-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Vida V. Bliokas ◽

Alex R. Hains ◽

Jonathan A. Allan ◽

Luise Lago ◽

Rebecca Sng

Keyword(s):

Emergency Department ◽

High Risk ◽

Suicide Attempt ◽

Repeated Measures ◽

Hospital Emergency Department ◽

Hospital Emergency ◽

Community Based ◽

Treatment As Usual ◽

The Impact

Abstract Background Suicide is a major public health issue worldwide. Those who have made a recent suicide attempt are at high risk for dying by suicide in the future, particularly during the period immediately following departure from a hospital emergency department. As such the transition from hospital-based care to the community is an important area of focus in the attempt to reduce suicide rates. There is a need for evaluation studies to test the effectiveness of interventions directed to this stage (termed ‘aftercare’ interventions). Methods A controlled non-randomised two group (intervention vs treatment-as-usual control) design, using an intention-to-treat model, will evaluate the effectiveness of a suicide prevention aftercare intervention providing follow-up after presentations to a hospital emergency department as a result of a suicide attempt or high risk for suicide. The intervention is a community-based service, utilising two meetings with a mental health clinician and follow-up contacts by peer workers via a combination of face-to-face and telephone for four weeks, with the option of extension to 12 weeks. Seventy-five participants of the intervention service will be recruited to the study and compared to 1265 treatment-as-usual controls. The primary hypotheses are that over 12 months, those who participate in the aftercare follow-up intervention are less likely than controls to present to a hospital emergency department for a repeat suicide attempt or because of high risk for suicide, will have fewer re-presentations during this period and will have lower all-cause mortality. As a secondary aim, the impact of the intervention on suicide risk factors for those who participate in the service will be evaluated using pre- and post-intervention repeated measures of depression, anxiety, stress, hopelessness, belongingness, burdensomeness, and psychological distress. Enrolments into the study commenced on 1 November 2017 and are anticipated to cease in November 2019. Discussion The study aims to contribute to the understanding of effective interventions for individuals who have presented to a hospital emergency department as a result of a suicide attempt or at high risk for suicide and provide evidence in relation to interventions that incorporate peer-workers. Trial registration ACTRN12618001701213. Registered on 16 October 2018. Retrospectively registered.

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