scholarly journals Are primary care and continuity of care associated with asthma-related acute outcomes amongst children? A retrospective population-based study

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Sarah Cooper ◽  
Elham Rahme ◽  
Sze Man Tse ◽  
Roland Grad ◽  
Marc Dorais ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Continuity Of Care ◽  
Hospital Admissions ◽  
Population Based ◽  
Logistic Regression Models ◽  
Children With Asthma ◽  
Care Models ◽  
Ed Visits ◽  
Asthma Outcomes

Abstract Background Having a primary care provider and a continuous relationship may be important for asthma outcomes. In this study, we sought to determine the association between 1) having a usual provider of primary care (UPC) and asthma-related emergency department (ED) visits and hospitalization in Québec children with asthma and 2) UPC continuity of care and asthma outcomes. Methods Population-based retrospective cohort study using Québec provincial health administrative data, including children 2-16 years old with asthma (N = 39, 341). Exposures and outcomes were measured from 2010-2011 and 2012-2013, respectively. Primary exposure was UPC stratified by the main primary care models in Quebec (team-based Family Medicine Groups, family physicians not in Family Medicine Groups, pediatricians, or no assigned UPC). For those with an assigned UPC the secondary exposure was continuity of care, measured by the UPC Index (high, medium, low). Four multivariate logistic regression models examined associations between exposures and outcomes (ED visits and hospitalizations). Results Overall, 17.4% of children had no assigned UPC. Compared to no assigned UPC, having a UPC was associated with decreased asthma-related ED visits (pediatrician Odds Ratio (OR): 0.80, 95% Confidence Interval (CI) [0.73, 0.88]; Family Medicine Groups OR: 0.84, 95% CI [0.75,0.93]; non-Family Medicine Groups OR: 0.92, 95% CI [0.83, 1.02]) and hospital admissions (pediatrician OR: 0.66, 95% CI [0.58, 0.75]; Family Medicine Groups OR: 0.82, 95% CI [0.72, 0.93]; non-Family Medicine Groups OR: 0.76, 95% CI [0.67, 0.87]). Children followed by a pediatrician were more likely to have high continuity of care. Continuity of care was not significantly associated with asthma-related ED visits. Compared to low continuity, medium and high continuity of care decreased asthma-related hospital admissions, but none of these associations were significant. Conclusion Having a UPC was associated with reduced asthma-related ED visits and hospital admissions. However, continuity of care was not significantly associated with outcomes. The current study provides ongoing evidence for the importance of primary care in children with asthma.

scholarly journals Trends in healthcare use in children aged less than 15 years: a population-based cohort study in England from 2007 to 2017

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e033761 ◽  
Author(s):  
Judith Ruzangi ◽  
Mitch Blair ◽  
Elizabeth Cecil ◽  
Geva Greenfield ◽  
Alex Bottle ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Hospital Admissions ◽  
Population Based ◽  
Urgent Care ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Emergency Hospital ◽  
Outpatient Visits ◽  
Ed Visits

ObjectiveTo describe changing use of primary care in relation to use of urgent care and planned hospital services by children aged less than 15 years in England in the decade following major primary care reforms from 2007 to 2017DesignPopulation-based retrospective cohort study.MethodsWe used linked data from the Clinical Practice Research Datalink to study children’s primary care consultations and use of hospital care including emergency department (ED) visits, emergency and elective admissions to hospital and outpatient visits to specialists.ResultsBetween 1 April 2007 and 31 March 2017, there were 7 604 024 general practitioner (GP) consultations, 981 684 ED visits, 287 719 emergency hospital admissions, 2 253 533 outpatient visits and 194 034 elective admissions among 1 484 455 children aged less than 15 years. Age-standardised GP consultation rates fell (−1.0%/year) to 1864 per 1000 child-years in 2017 in all age bands except infants rising by 1%/year to 6722 per 1000/child-years in 2017. ED visit rates increased by 1.6%/year to 369 per 1000 child-years in 2017, with steeper rises of 3.9%/year in infants (780 per 1000 child-years in 2017). Emergency hospital admission rates rose steadily by 3%/year to 86 per 1000 child-years and outpatient visit rates rose to 724 per 1000 child-years in 2017.ConclusionsOver the past decade since National Health Service primary care reforms, GP consultation rates have fallen for all children, except for infants. Children’s use of hospital urgent and outpatient care has risen in all ages, especially infants. These changes signify the need for better access and provision of specialist and community-based support for families with young children.

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 Cohort profile: CROSS-TRACKS: a population-based open cohort across healthcare sectors in Denmark

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039996
Author(s):  
Anders Hammerich Riis ◽  
Pia Kjær Kristensen ◽  
Matilde Grøndahl Petersen ◽  
Ninna Hinchely Ebdrup ◽  
Simon Meyer Lauritsen ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Primary Care ◽  
Hospital Admissions ◽  
Smoking Status ◽  
Population Based ◽  
Fertility Treatment ◽  
Study Patient ◽  
Transfer Payment ◽  
Sociodemographic Characteristics ◽  
Patient Pathways

PurposeThis paper describes the open cohort CROSS-TRACKS, which comprises population-based data from primary care, secondary care and national registries to study patient pathways and transitions across sectors while adjusting for sociodemographic characteristics.ParticipantsA total of 221 283 individuals resided in the four Danish municipalities that constituted the catchment area of Horsens Regional Hospital in 2012–2018. A total of 96% of the population used primary care, 35% received at least one transfer payment and 66% was in contact with a hospital at least once in the period. Additional clinical information is available for hospital contacts (eg, alcohol intake, smoking status, body mass index and blood pressure). A total of 23% (n=8191) of individuals aged ≥65 years had at least one potentially preventable hospital admission, and 73% (n=5941) of these individuals had more than one.Findings to dateThe cohort is currently used for research projects in epidemiology and artificial intelligence. These projects comprise a prediction model for potentially preventable hospital admissions, a clinical decision support system based on artificial intelligence, prevention of medication errors in the transition between sectors, health behaviour and sociodemographic characteristics of men and women prior to fertility treatment, and a recently published study applying machine learning methods for early detection of sepsis.Future plansThe CROSS-TRACKS cohort will be expanded to comprise the entire Central Denmark Region consisting of 1.3 million residents. The cohort can provide new knowledge on how to best organise interventions across healthcare sectors and prevent potentially preventable hospital admissions. Such knowledge would benefit both the individual citizen and society as a whole.

scholarly journals New teams in general practice

2018 ◽  
Vol 11 (9) ◽  
pp. 506-512 ◽  
Author(s):  
Kamila Hawthorne ◽  
Ben Jackson ◽  
Danielle Fisher
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Continuity Of Care ◽  
Healthcare Professionals ◽  
Hospital Admissions ◽  
Healthcare Outcomes ◽  
Complex Patients ◽  
Primary Care Teams ◽  
A Priority ◽  
Parallel Stream

The NHS is seriously under-doctored, with general practice being one of the worst-affected specialties. GPs are a highly trusted and valued profession by patients. In addition, the ‘gatekeeping’ function and continuity of care they provide is critical to the efficiency of the services as a whole, keeps hospital admissions down, and produces better healthcare outcomes for communities and populations. Major efforts are being made to recruit new GPs and retain existing GPs, but there are serious implications for the future of primary care, and general practice in particular, as GPs struggle to cope with increased workloads. Increasing the number of GPs in the workforce is critical, and this work continues as a priority. However, a parallel stream of work has developed to consider ways in which tasks ‘traditionally’ undertaken by a GP might be diverted to new healthcare professionals within primary care teams, freeing up GPs to concentrate on the care and management of their more complex patients.

The Association Between Continuity of Primary Care and Preventive Cancer Screening in Women With Intellectual Disability

2018 ◽  
Vol 123 (6) ◽  
pp. 499-513 ◽  
Author(s):  
Natasha Plourde ◽  
Hilary K. Brown ◽  
Simone Vigod ◽  
Virginie Cobigo
Keyword(s):  
Primary Care ◽  
Cervical Cancer ◽  
Intellectual Disability ◽  
Cancer Screening ◽  
Social Services ◽  
Continuity Of Care ◽  
Pap Test ◽  
Population Based ◽  
Breast And Cervical Cancer ◽  
To Receive

Abstract Women with intellectual disability have low screening rates for breast and cervical cancer. This population-based cohort study examined the association between the level of primary care continuity and breast and cervical cancer screening rates in women with intellectual disability. Data were obtained from the Institute for Clinical Evaluative Sciences and the Ontario Ministry of Community and Social Services. Neither high (adjusted OR [aOR] = 1.06; 95% CI: 0.88-1.29) nor moderate (aOR = 1.11; 95% CI: 0.91-1.36) continuity of care were associated with mammography screening. Women were less likely to receive a Pap test with high (aOR = 0.70; 95% CI: 0.64-0.77) and moderate (aOR = 0.81, 95% CI 0.74-0.89) versus low continuity of care. Improving continuity of care may not be sufficient for increasing preventive screening rates.

scholarly journals Population-Based Longitudinal Study of Follow-Up Care for Patients With Colorectal Cancer in Nova Scotia

2012 ◽  
Vol 8 (4) ◽  
pp. 246-252 ◽  
Author(s):  
Robin Urquhart ◽  
Amy Folkes ◽  
Geoffrey Porter ◽  
Cynthia Kendell ◽  
Martha Cox ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Longitudinal Study ◽  
Nova Scotia ◽  
Continuity Of Care ◽  
Guideline Adherence ◽  
Population Based ◽  
Follow Up Care

Transitioning routine follow-up to primary care could potentially increase guideline adherence by improving access to and continuity of care.

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.

scholarly journals The Use of Telemedicine Access to Schools to Facilitate Expert Assessment of Children with Asthma

2008 ◽  
Vol 2008 ◽  
pp. 1-7 ◽  
Author(s):  
David A. Bergman ◽  
Paul J. Sharek ◽  
Kathryn Ekegren ◽  
Shannon Thyne ◽  
Michelle Mayer ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Physician ◽  
Expert Assessment ◽  
Asthma Care ◽  
School Based ◽  
Follow Up Care ◽  
Children With Asthma ◽  
Asthma Outcomes ◽  
Improve Access

Research has shown that access to an asthma specialist improves asthma outcomes. We hypothesized that we could improve access to expert asthma care through a telemedicine link between an asthma specialist and a school-based asthma program. We conducted a prospective cohort study in 3 urban schools to ascertain the feasibility of using an asthma-focused telemedicine solution. Each subject was seen by an asthma expert at 0, 8, and 32 weeks. The assessment and recommendations for care were sent to the primary care physician (PCP) and parents were told to contact their physician for follow-up care. Eighty three subjects participated in the study. Subjects experienced improvement (P<.05) in family social activities and the number of asthma attacks. Ninety four percent of subjects rated the program as good or excellent. This study demonstrates the feasibility and acceptance of a school-based asthma program using a telemedicine link to an asthma specialist.

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