Access to Primary Care From the Perspective of Aboriginal Patients at an Urban 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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Access to primary care and cognitive impairment: results from a national community study of aging Americans

BMC Geriatrics ◽

10.1186/s12877-021-02545-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Megan A. Mullins ◽

Julie P. W. Bynum ◽

Suzanne E. Judd ◽

Philippa J. Clarke

Keyword(s):

Primary Care ◽

Health Care ◽

Emergency Department ◽

Cognitive Impairment ◽

Racial Differences ◽

Care Service ◽

Emergency Department Utilization ◽

Care Utilization ◽

Access To Primary Care ◽

Primary Care Supply

Abstract Background Despite a growing burden of Alzheimer’s Disease and related dementias (ADRD) in the US, the relationship between health care and cognitive impairment prevention is unclear. Primary care manages risk causing conditions and risk reducing behaviors for dementia, so we examine the association between individual and area-level access to primary care and cognitive impairment in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Methods REGARDS participants with a cognitive assessment and vascular measurements at their baseline visit were included in this cross-sectional analysis. Cognitive impairment was defined as a Six-Item Screener (SIS) score < 5. Primary care supply, primary care utilization and emergency department (ED) utilization were measured at the primary care service area (PCSA) level based on participant’s address. Individual access to care was self-reported. Models were adjusted for confounding by demographics, socioeconomic status and behavioral risk factors. Results Among 25,563 adults, living in a PCSA with low primary care supply was associated with 25% higher odds of cognitive impairment (OR 1.25 CI 1.07-1.45). Not having a regular source of medical care was associated with 14% higher odds of cognitive impairment (OR 1.14 CI 1.02-1.28), and living in a PCSA with high emergency department utilization was associated with 12% higher odds of cognitive impairment (OR 1.12 CI 1.02-1.23). Conclusions Our results are an important first step in understanding how health care may prevent cognitive impairment. They highlight the importance of primary care and suggest future work clarifying its role in preventing cognitive decline is imperative.

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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 ◽

10.1161/circ.141.suppl_1.p331 ◽

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.

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After-Hours Access To Primary Care Practices Linked With Lower Emergency Department Use And Less Unmet Medical Need

Health Affairs ◽

10.1377/hlthaff.2012.0494 ◽

2013 ◽

Vol 32 (1) ◽

pp. 175-183 ◽

Cited By ~ 79

Author(s):

Ann S. O’Malley

Keyword(s):

Primary Care ◽

Emergency Department ◽

Emergency Department Use ◽

Medical Need ◽

After Hours ◽

Care Practices ◽

Access To Primary Care ◽

Primary Care Practices

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LO087: Emergency department patients’ connection to primary care providers: reasons for lack of connection

CJEM ◽

10.1017/cem.2016.124 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S60-S60

Author(s):

L. Krebs ◽

S.W. Kirkland ◽

K. Crick ◽

C. Villa-Roel ◽

A. Davidson ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Family Physician ◽

Patient Characteristics ◽

Primary Care Providers ◽

Care Providers ◽

Care Access ◽

Care Services ◽

Primary Care Services ◽

Access To Primary Care

Introduction: Some non-urgent/low-acuity Emergency Department (ED) presentations are considered convenience visits and potentially avoidable with improved access to primary care services. This study surveyed patients who presented to the ED and explored their self-reported reasons and barriers for not being connected to a primary care provider (PCP). Methods: Patients aged 17 years and older were randomly selected from electronic registration records at three urban EDs in Edmonton, Alberta (AB), Canada. Following initial triage, stabilization, and verbal informed consent, patients completed a 47-item questionnaire. Data from the survey were cross-referenced to a minimal patient dataset consisting of ED and demographic information. The questionnaire collected information on patient characteristics, their connection to a PCP, and patients' reasons for not having a PCP. Results: Of the 2144 eligible patients, 1408 (65.7%) surveys were returned and 1402 (65.4%) were completed. The majority of patients (74.4%) presenting to the ED reported having a family physician; however, the ‘closeness’ of the connection to their family physician varied greatly among ED patients with the most recent family physician visit ranging from 1 hour before ED presentation to 45 years prior. Approximately 25% of low acuity ED patients reported no connection with a family physician. Reasons for a lack of PCP connection included: prior physician retired, left, or died (19.8%), they had never tried to find one (19.2%), they had recently moved to Alberta (18.0%), and they were unable to find one (16.5%). Conclusion: A surprisingly high proportion of ED patients (25.6%) have no identified PCP. Patients had a variety of reasons for not having a family physician. These need to be understood and addressed in order for primary care access to successfully contribute to diverting non-urgent, low acuity presentations from the ED.

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