Abstract P331: Impact of Primary Care Access and Continuity of Care in Reduction of Hospital/Emergency Department Admissions in Patients With Hypertension: A Systematic Review

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Divya Rajmohan ◽  
Konstantin Golubykh ◽  
Anastasiia Avdeeva ◽  
Ashraf Mahmood ◽  
Muhammad Sarmad Aleem ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Emergency Department ◽  
Ambulatory Care ◽  
Continuity Of Care ◽  
Ambulatory Care Sensitive Conditions ◽  
Primary Care Access ◽  
Care Access ◽  
Ed Visits ◽  
Access To Primary Care

Background: Hypertension, defined as a systolic blood pressure ≥140 mmHg and/or diastolic pressure ≥90 mmHg, is one of the most common chronic diseases (prevalence is 29.0% among adults) and is part of the Ambulatory Care Sensitive Conditions (ACSC). In most cases, hypertension is considered a secondary diagnosis because complications that could result from the disease are the reasons why patients with hypertension are admitted to the hospital and Emergency Department (ED). Thereby, preventive approaches are integral in the management of these complications and access to primary care along with continuity are considered to be crucial components of preventive medicine. Hypothesis: We assess the hypothesis that increased access to primary care and continuity of care can reduce ED visits along with hospitalization rates in patients with hypertension. Methods: We reviewed articles from years 2005 to 2019 from peer reviewed journals. All publications were written in English and were mostly from the United States. However, we also included studies from other countries for comparison. We identified 2115 articles in total: 784 from Science Direct, 687 from Pubmed and 644 from Google Scholar, using these keywords: Hypertension, Hospitalization, Emergency Department, Primary care, Ambulatory Care Sensitive Conditions. Based on the titles, we investigated abstracts of 198 potentially relevant articles. Abstracts were rated independently by each member of the pair of reviewers and scored for relevance (relevant/ non-relevant). The second step was to have the full text of the remaining studies (n = 146) reviewed by the same team to check whether papers met inclusion criteria. Through this process, 96 studies were excluded. A total of 50 studies remained and were included in our systematic review. Results: From 50 research articles that were included; 38 studies showed statistically significant (p < 0.05) finding that increased access to primary care and its continuity decreases hospitalizations and/or ED admissions in patients with hypertension, 8 studies did not find statistically significant association between these factors. 4 studies showed statistically significant conclusion that general or family physicians as PCPs decrease hospitalization and ED admission rate in comparison with specialist physicians as PCP. Conclusion: We concluded that increased primary care access and its continuity are associated with a statistically significant decrease in the incidence of hospitalizations and/or ED visits for patients with hypertension.

scholarly journals Low-acuity emergency department use among patients in different primary care models in Hamilton and Ontario

2021 ◽  
pp. 084047042110120
Author(s):  
Olivia Ly ◽  
David Price ◽  
Refik Saskin ◽  
Michelle Howard
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Population Based ◽  
Fee For Service ◽  
Primary Care Access ◽  
Care Access ◽  
Care Models ◽  
Ed Visits ◽  
Primary Care Practices ◽  
The Impact

Jurisdictions such as Hamilton, Ontario, where most primary care practices participate in patient enrolment models with enhanced after-hours access, may demonstrate overall improved health equity outcomes. Non-urgent Emergency Department (ED) use has been suggested as an indicator of primary care access; however, the impact of primary care access on ED use is uncertain and likely varies by patient and contextual factors. This population-based, retrospective study investigated whether or not different primary care models were associated with different rates of non-urgent ED visits in Hamilton, a city with relatively high neighbourhood marginalization, compared to the rest of Ontario from 2014/2015 to 2017/2018. In Ontario, enrolment capitation-based practices had more non-urgent ED visits than non-enrolment fee-for-service practices. In Hamilton, where most of the city’s family physicians are in enrolment capitation-based practices, differences between models were minimal. The influence of primary care reforms may differ depending on how they are distributed within regions.

scholarly journals Emergency department visits for ambulatory care sensitive conditions

2019 ◽  
Vol 53 ◽  
Author(s):  
Ana Cláudia Medeiros Galvão de Lima ◽  
Lúcia Yasuko Izumi Nichiata ◽  
Daiana Bonfim
Keyword(s):  
Emergency Department ◽  
Ambulatory Care ◽  
Emergency Department Visits ◽  
Ambulatory Care Sensitive Conditions ◽  
Chronic Patients ◽  
Poor Access ◽  
Margin Of Error ◽  
Access To Primary Care ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

ABSTRACT Objective: To describe emergency department visits for ambulatory care sensitive conditions. Method: Exploratory, descriptive, ecological, quantitative study. From January 2015 to December 2016, was accessed the database with information of visits performed in an emergency department located in the region of Campo Limpo, municipality of São Paulo. A 99% confidence interval was considered for the incidence of visits with identification of ambulatory care sensitive conditions, and a margin of error of 0.4%. The analyzes were performed with use of the statistical package SPSS. Results: We found 434,883 visits, of which 17.1% were due to ambulatory care sensitive conditions, mostly of women and children up to 4 years of age. The reason for most visits were ear, nose and throat infections (45.4%). There was a higher chance of visits for the indicator in chronic patients (p<0.001). Conclusion: This study demonstrated the emergency department ambulatory care sensitive conditions visits that may indicate poor access to primary care.

Using Google Trends to track walk-in clinic and emergency department searches over time and across provinces in Canada (Preprint)

2019 ◽  
Author(s):  
Joseph Ssendikaddiwa ◽  
Ruth Lavergne
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
British Columbia ◽  
Emergency Departments ◽  
Google Trends ◽  
Care Seeking ◽  
Primary Care Access ◽  
Care Access ◽  
After Hours ◽  
Over Time

BACKGROUND Access to primary care is a challenge for many Canadians. Models of primary care vary widely across provinces, including arrangements for same day and after-hours access. Use of walk-in clinics and emergency departments may also vary, but data sources that allow comparison are limited. OBJECTIVE We use Google Trends to examine searches for walk-in clinics and emergency departments across provinces and over time in Canada, and compare results to other information about primary care access. METHODS We developed search strategies to capture the range of terms used for walk-in clinics (e.g. urgent care clinic, after-hours clinic) and emergency departments (e.g. ER, emergency room) across Canadian provinces. We used Google Trends to determine the frequencies of these terms relative to total search volume, and standardized search frequencies to allow comparisons across provinces and over time (2011-2018). We explored how care seeking captured by Google Trends correlates with other sources of data on primary care access by province. RESULTS Manitoba, British Columbia, and Nova Scotia had highest search frequency for emergency departments, and Saskatchewan, Alberta, and Ontario had the lowest. Searches for walk-in clinics were most common in the western provinces of British Columbia, Alberta, and Saskatchewan. Relative search frequency for walk-in clinics increased steadily, doubling in most provinces between 2011 and 2018. Higher search frequency for walk-in clinics was correlated with ability to get a same or next-day appointment and inversely correlated with both ED use for conditions treatable in patients’ regular place of care and having a regular medical provider. Emergency department searches were not correlated with survey data. CONCLUSIONS Search frequencies may reflect patient care seeking but may also be impacted by news coverage and other events, especially in the case of emergency department searches. We observe substantial interprovincial variation, and marked growth in the frequency of searches for walk-in clinics. Google Searches for walk-in clinics correlate with other measures of access, and appear to correspond to differences in policies related to walk-in clinics, advanced access, and after-hours care between provinces.

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