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.

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 Impact of a Student-Run Clinic on Emergency Department Utilization

2019 ◽  
Vol 51 (5) ◽  
pp. 420-423 ◽  
Author(s):  
Anjali B. Thakkar ◽  
Pooja Chandrashekar ◽  
Wei Wang ◽  
Bonnie B. Blanchfield
Keyword(s):  
Low Income ◽  
Emergency Department Utilization ◽  
Primary Care Access ◽  
Care Access ◽  
Appropriate Care ◽  
Average Change ◽  
Source Of Care ◽  
Ed Visits ◽  
Value Based Care ◽  
The Impact

Background and Objectives: Student-run clinics (SRCs) provide primary care access to low-income patients who would otherwise pursue more expensive care, such as visits to emergency departments (ED). Decreasing inappropriate ED utilization offers an opportunity to create value in the health care system. However, to date, no SRC has rigorously studied this. This study examines whether increased access to ambulatory care through an SRC, the Crimson Care Collaborative (CCC), is associated with decreased ED utilization, providing value to payers and providers, and justifying investment in SRCs. Methods: We conducted a 5-year retrospective analysis of 796 patients to determine if ED utilization changed after patients enrolled in CCC. We used patient-level ED visit data to estimate the average change in ED utilization. A regression analysis examined the impact of demographic and clinical variables on changes in ED utilization. Results: Average per-patient ED utilization significantly (P&lt;0.001) decreased by 23%, 50%, and 48% for patients enrolling in CCC from 2013 to 2015, respectively. Following enrollment in CCC, average ED utilization decreased by 0.39 visits per patient per year. This translates to 62.01 avoided ED visits annually, and estimated payer savings of $84,148, representing 68% of the clinic’s direct operating costs. Conclusions: CCC created value to payers and providers from 2013-2015 by providing a lower-cost source of care and increasing ED capacity for more emergent and appropriate care. This study suggests that SRCs can create financial value for both payers and providers while also providing an avenue to teach value-based care in medical education.

scholarly journals The impact of COVID-19 on hospital admissions and emergency department visits: A population-based study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252441
Author(s):  
Elissa Rennert-May ◽  
Jenine Leal ◽  
Nguyen Xuan Thanh ◽  
Eddy Lang ◽  
Shawn Dowling ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Hospital Admissions ◽  
Population Based ◽  
Emergency Department Visits ◽  
System Capacity ◽  
Population Based Study ◽  
Health Measures ◽  
Ed Visits ◽  
The Impact

Background As a result of the novel coronavirus disease 2019 (COVID-19), there have been widespread changes in healthcare access. We conducted a retrospective population-based study in Alberta, Canada (population 4.4 million), where there have been approximately 1550 hospital admissions for COVID-19, to determine the impact of COVID-19 on hospital admissions and emergency department (ED visits), following initiation of a public health emergency act on March 15, 2020. Methods We used multivariable negative binomial regression models to compare daily numbers of medical/surgical hospital admissions via the ED between March 16-September 23, 2019 (pre COVID-19) and March 16-September 23, 2020 (post COVID-19 public health measures). We compared the most frequent diagnoses for hospital admissions pre/post COVID-19 public health measures. A similar analysis was completed for numbers of daily ED visits for any reason with a particular focus on ambulatory care sensitive conditions (ACSC). Findings There was a significant reduction in both daily medical (incident rate ratio (IRR) 0.86, p<0.001) and surgical (IRR 0.82, p<0.001) admissions through the ED in Alberta post COVID-19 public health measures. There was a significant decline in daily ED visits (IRR 0.65, p<0.001) including ACSC (IRR 0.75, p<0.001). The most common medical/surgical diagnoses for hospital admissions did not vary substantially pre and post COVID-19 public health measures, though there was a significant reduction in admissions for chronic obstructive pulmonary disease and a significant increase in admissions for mental and behavioral disorders due to use of alcohol. Conclusions Despite a relatively low volume of COVID-19 hospital admissions in Alberta, there was an extensive impact on our healthcare system with fewer admissions to hospital and ED visits. This work generates hypotheses around causes for reduced hospital admissions and ED visits which warrant further investigation. As most publicly funded health systems struggle with health-system capacity routinely, understanding how these reductions can be safely sustained will be critical.

Postpartum emergency department use among women with intellectual and developmental disabilities: a retrospective cohort study

2019 ◽  
Vol 73 (6) ◽  
pp. 557-563 ◽  
Author(s):  
Monika Mitra ◽  
Ilhom Akobirshoev ◽  
Susan L Parish ◽  
Anne Valentine ◽  
Karen M Clements ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Emergency Department ◽  
Developmental Disabilities ◽  
Postpartum Period ◽  
Post Partum ◽  
Population Based ◽  
Intellectual And Developmental Disabilities ◽  
Healthcare Needs ◽  
Ed Visits

BackgroundAn emerging body of evidence underscores the often-intensive perinatal healthcare needs of women with intellectual and developmental disabilities (IDD). However, population-based research examining postpartum experiences of US women with IDD is sparse. We examined emergency department (ED) use in the postpartum period among Massachusetts mothers with IDD.MethodsWe analysed 2002–2010 Massachusetts Pregnancy to Early Life Longitudinal data to compare any and ≥2 ED visits between mothers with and without IDD: within 1–42 days post partum, 1–90 days post partum and 1–365 days post partum. We also determined whether or not such ED use was non-urgent or primary-care sensitive.ResultsWe identified 776 births in women with IDD and 595 688 births in women without IDD. Across all three postpartum periods, women with IDD were vastly more likely to have any postpartum ED use, to have ≥2 ED visits and to have ED visits for mental health reasons. These findings persisted after controlling for numerous sociodemographic and clinical characteristics. Women with IDD were less likely to have non-urgent ED visits during the three postpartum periods and they were less likely to have primary-care sensitive ED visits during the postpartum period.ConclusionThese findings contribute to the emerging research on perinatal health and healthcare use among women with IDD. Further research examining potential mechanisms behind the observed ED visit use is warranted. High ED use for mental health reasons among women with IDD suggests that their mental health needs are not being adequately met.

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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