scholarly journals Association of Patients’ Perception of Primary Care Provider Listening With Emergency Department Use

PRiMER ◽  
2020 ◽  
Vol 4 ◽  
Author(s):  
Katie Hinderaker ◽  
Amanda Weinmann
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Primary Care Providers ◽  
California Health Interview Survey ◽  
Care Providers ◽  
Emergency Department Use ◽  
Younger Age ◽  
Interview Survey ◽  
Ed Visits ◽  
African American Race

Introduction: This study examined whether patients’ perceptions of their primary care providers’ (PCP) listening frequency were associated with emergency department (ED) utilization, including a comparison to patients without PCPs. Methods: Data were obtained from the 2015 California Health Interview Survey. Respondents were asked if they had a PCP and how often their PCPs listened, resulting in five groups: patients without a PCP (n=4,407), and patients with a PCP who perceived the PCP’s listening frequency to be never (n=254), sometimes (n=1,282), usually (n=3,440), or always (n=11,651). Multiple linear regression was performed to determine if patient-perceived listening frequency of the PCP was associated with the patient’s number of ED visits in the prior year, adjusting for various demographic, social, and health factors. Results: Compared to patients without a PCP, patients with a PCP had on average 0.15 more ED visits in a year, highest among those whose PCPs were perceived as listening the least: never=0.55 more visits per year (95% CI: 0.09-1.02, P=.02), sometimes=0.26 (0.01-0.51, P=.04), usually=0.03 (-0.17-0.24, P=.73), and always=0.16 (-0.05-0.36, P=.13). Other significant increases in ED visits were associated with public insurance, African-American race, English proficiency, younger age, self-rated fair-to-poor health, asthma, and hypertension. Conclusions: Patients who perceived their PCP as listening less frequently had more ED visits than patients whose PCPs were perceived as listening more frequently, and compared to patients without a PCP.

scholarly journals MP05: Injuries in refugee children presenting to a paediatric emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S41-S42
Author(s):  
E. Zhang ◽  
F. Razik ◽  
S. Ratnapalan
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Primary Care Physicians ◽  
Clinical Care ◽  
Tertiary Care ◽  
Primary Care Providers ◽  
Refugee Children ◽  
Medical Attention ◽  
Care Providers ◽  
Ed Visits

Introduction: The number of refugees accepted to Canada grew from 24,600 in 2014 to 46,700 in 2016. Many of these refugees have young families and the number of child refugees has increased accordingly. Although child refugee health care has been in the forefront of media and medical attention recently, there is limited data on injury patterns in this population. Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) collects data on injuries in children presenting to the emergency department (ED). Our objective is to examine the clinical presentations and outcomes of refugee children with injuries presenting to a tertiary care paediatric ED. Methods: Our paediatric hospital has approximately 70,000 ED visits per year of which 13,000 are due to injuries and/or poisonings. The CHIRPP database was accessed to identify children with injuries presenting to our ED from April 2014 to March 2017 with Interim Federal Health Program (IFHP) registration status. All patient charts were reviewed to extract demographic and clinical care information. Results: There were 74 children with 81 ED visits during the study period of whom 19% were transferred from other facilities. Most of them (72%) were males with a mean age of 8.7 years (standard deviation 4.29). There were significant medical histories in 32% of children. The presentation to our ED (greater than 24 hours post-injury) was seen in 25% of visits. Twenty five percent of injured children were seen in our ED. The distribution of Canadian Triage Acuity Score (CTAS) scores 1, 2, 3, 4, and 5 were 0%, 16%, 37%, 46% and 1% respectively. However, subspecialty consultations were required in 69%, 60% and 27% of CTAS 2, 3 and 4 children respectively. Overall, 46% of all patients required subspecialty consults. The top three categories of injuries include fractures (23%), soft tissue injuries (20%) and lacerations (17%). More than half (56%) required diagnostic imaging. Most (89%) were treated in ED and discharged (average length-of-stay 3 hours 55 minutes) and 11% required admissions. 47% of children lacked primary care physicians. Conclusion: Almost half of refugee children with IFHP status require DI testing, sub-specialty consultations and primary care referrals when presenting to our ED with injuries. Follow up arrangements are needed as many do not have access to primary care providers. This demonstrates a need for securing primary care providers early for this vulnerable population.

scholarly journals The Role of Primary Care in Asthma Control and Severity

Spectrum ◽  
2019 ◽  
Author(s):  
Joel Agarwal ◽  
Monette Dimitrov ◽  
Kerri MacKay ◽  
Alan Kaplan ◽  
Donald Cockcroft ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Emergency Department ◽  
Asthma Control ◽  
Primary Care Providers ◽  
Care Utilization ◽  
Life Questionnaire ◽  
Care Providers ◽  
Ed Visits

Background: Asthma is a common chronic inflammatory disease of the airways affecting 3 millionCanadians. Primary Care Providers (PCPs) are integral to care coordination, enhanced through thedevelopment of a strong patient-PCP relationship with Continuity of Care (COC). A recent CIHI studynoted that 40% of Albertans do not have a COC model for primary care.Objectives: We aim to evaluate how primary care for adults with asthma impacts different measures ofcontrol.Methods: Prospective population-based recruitment of adults through various community venuesacross Alberta. Those who had self-reported asthma and were willing to participate completed a surveywhich included demographics, comorbidities, medication use (including biologics, allergy medications,steroids), Asthma Control Questionnaire (ACQ-5), Asthma Control Test (ACT), Quality of Life (QoL)measured through the mini-Asthma Quality of Life Questionnaire (mini-AQLQ) and health care utilization(including Emergency Department (ED) visits, hospitalizations and ICU stays for asthma).Results: Of the 1685 individuals approached, 61 (3.6%) reported having asthma, of which 47 lived inAlberta. Most (41, 87%) had a PCP, with 30 (64%) visiting their PCP at least twice a year. Uncontrolledasthma was noted in 21 (45%) with either the ACQ-5 or ACT. The mini-AQLQ indicated 5 (11%) withreduced QoL. Mean lifetime hospitalizations, lifetime Emergency Department (ED) visits, and ICU staysrelated to asthma were 1.52, 4.55 and 0.25 respectively. Further, mean hospitalizations and ED visits inthe past 12 months related to asthma were 0.05 and 0.30 respectively.Conclusions: Asthma control was poor in 21 (45%) surveyed individuals, suggesting sub-optimal asthmamanagement in Alberta. Knowledge of Primary Care Networks (PCNs) was low, while ED and hospitalusage was high.

scholarly journals Approaches for Improving Health Equity: The Effect of The Gainesville Community Resource Paramedic Program on Reducing Emergency Department Utilization

2020 ◽  
Author(s):  
Andrew S Cistola ◽  
Ariella N Bak ◽  
Laura Guyer ◽  
Austin Reed ◽  
Ben Rooks ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Primary Care Providers ◽  
Emergency Department Utilization ◽  
Care Providers ◽  
Community Resource ◽  
Paired Samples ◽  
Before And After ◽  
Ed Visits ◽  
Student’S T

Abstract Background. The U.S. healthcare system has consistently struggled with inefficiencies in Emergency Department (ED) usage (Enard & Ganelin, 2013). Other studies have established that interventions focusing on care coordination are not able to reduce utilization (Finkelstein, 2020), and current ED reduction programs in the literature focus on establishing patients in primary care (Raven, 2016). In community paramedicine programs, paramedics collaborate with interdisciplinary partners to address the needs of patients outside of traditional health care settings. The Gainesville Community Resource Paramedic Program (Gainesville CRP) was implemented in 2017 to provide an intervention to address social determinants that primary care providers (PCP) cannot address. Methods. A Student’s t-test for paired samples was used to compare total ED visits as well as ED visits with and without hospital admission six months before and after program enrollment. Pearson’s correlation between final change in total ED visits and total PCP visits for pre-CRP, post-CRP, and full-CRP were calculated to determine if there was evidence for bias in utilization patterns. Results. Among program participants (n = 53), significant reductions were observed among total (mean = 2.94, p < 0.001), without admission (mean = 1.30, p = 0.006), and with admission (mean = 1.64, p = 0.002). Significant reductions were also found among selected demographics and morbidities. Reductions in total ED visits were not associated with visits to a PCP before, after, or throughout. Conclusions. Gainesville CRP was able to reduce ED visits independent of PCPs indicating that the approach could inform other ED diversion programs.

Presentation and Referral Patterns in Pediatric Closed Hand Fractures

Hand ◽  
2021 ◽  
pp. 155894472110085
Author(s):  
Landis R. Walsh ◽  
Laura C. Nuzzi ◽  
Amir H. Taghinia ◽  
Brian I. Labow
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Pediatric Patients ◽  
Primary Care Providers ◽  
Care Providers ◽  
Referral Patterns ◽  
Old Patients ◽  
Hand Surgeon ◽  
Hand Fractures ◽  
The Mean

Background Although pediatric hand fractures are common and generally have good outcomes, they remain a considerable source of anxiety for non–hand surgeons, who are less familiar with these injuries. We hypothesized that this anxiety may manifest as inefficiency in referral patterns. Methods The records of pediatric patients with isolated, closed hand fractures without concurrent trauma seen at our institution by a hand surgeon between January 2017 and December 2018 were retrospectively reviewed. Results There were 454 patients included; 62.1% were men, and the mean age was 9.6 years at initial encounter. Most patients (89.6%) were treated nonoperatively and incurred few complications (0.5%). Roughly half of all cases (n = 262) initially presented to an outside provider. Of these, 24.0% (n = 64 of 262) were evaluated by 2+ providers before a hand surgeon. Most commonly, these patients were referred from an outside emergency department (ED) to our ED before hand surgeon evaluation (n = 45 of 64). Forty-seven patients required surgery; however, none were performed urgently. Although a greater proportion of 7- to 11-year-old patients saw 2+ providers prior to a hand surgeon ( P = .007), fewer required surgery ( P < .001). Conclusions Pediatric closed hand fractures are mainly treated nonoperatively and nonemergently with generally excellent outcomes. Our data suggest that many patients continue to be referred through the ED or multiple EDs/providers for treatment. These inefficient referral patterns demonstrate the need for better education for ED and primary care providers, as well as better communication between these providers and local pediatric hand surgeons. Advancements in these areas are likely to improve efficiency of care and decrease costs.

scholarly journals Seeking Care for Hyperglycemia in the Emergency Department: Through the Eyes of the Patient

2020 ◽  
Author(s):  
Justin W. Yan ◽  
Dimah Azzam ◽  
Melanie P. Columbus ◽  
Kristine Van Aarsen ◽  
Selina L. Liu ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Department ◽  
Hospital Admission ◽  
Health Care Systems ◽  
Primary Care Providers ◽  
Urgent Care ◽  
Care Providers ◽  
Health Care Settings ◽  
Care Systems

Health care systems often provide a range of options of care for patients with illnesses who do not require hospital admission. For individuals with diabetes, these options may include primary care providers, specialized diabetes clinics, and urgent care and walk-in clinics. We explored the reasons why patients choose the Emergency Department over other health care settings when seeking care for hyperglycemia.

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

CJEM ◽  
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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