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Bessert* B, Oltrogge-Abiry* JH, Peters PS, Schmalstieg-Bahr K, Bobardt-Hartshorn JS, Janis Pohontsch N, Bracht S, Mayer-Runge U, Scherer M. Synergism of an Urgent Care Walk-in Clinic With an Emergency Department. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:491-498. [PMID: 37378594 PMCID: PMC10511010 DOI: 10.3238/arztebl.m2023.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 12/16/2022] [Accepted: 05/11/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND The overutilization of hospital emergency departments by low-urgency patients is seen as a growing problem in health-care delivery, and a variety of solutions are under discussion. We studied the change in utilization of a hospital emergency department (ED) by low-urgency patients after an urgent care walk-in clinic (WIC) was opened in the immediate vicinity. METHODS A prospective, single-center pre-post comparative study was carried out at the University Medical Center Hamburg-Eppendorf (UKE). The ED patient collective consisted of adult walk-in patients who presented to the ED between 4 pm and midnight. The "pre" period consisted of August and September 2019, and the "post" period was from November 2019 (after the opening of the WIC) to January 2020. RESULTS The study patients consisted of 4765 ED walk-in patients and 1201 WIC patients. 956 (80.5%) of the WIC patients had been referred onward to the WIC after initially presenting to the ED; from this group, 790 patients (82.6%) received definitive care in the WIC. The number of outpatients treated in the ED fell by 37.3% (95% confidence interval [30.9; 43.8]), from 851.5 to 536.7 per month. The most marked decreases were in the areas of dermatology (from 62.5 to 14.3 patients per month), neurology (45.5 to 25), ophthalmology (115 to 64.7), and trauma surgery (211 to 128.7). No decrease was seen in urology, psychiatry, or gynecology. For patients presenting without any referral document, the mean length of stay fell by a mean of 17.6 [7.4; 27.8] minutes from its "pre" value of 172.3 minutes. The rate of patients who left during treatment fell from 76.5 to 28.3 patients per month (p < 0.001). CONCLUSION A GP-led urgent care walk-in clinic next door to an interdisciplinary hospital emergency department is a resource-saving treatment option for walk-in patients who present to the emergency department. Most of the patients referred from the ED to the WIC were able to receive definitive care there.
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Affiliation(s)
- Bastian Bessert*
- *These authors share first authorship
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Jan Hendrik Oltrogge-Abiry*
- *These authors share first authorship
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Penelope-Sophie Peters
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Germany
| | | | | | - Nadine Janis Pohontsch
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Svea Bracht
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Ulrich Mayer-Runge
- Interdiscplinary Central Emergency Department, University Medical Center Hamburg-Eppendorf, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Germany
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Benjamin P, Bryce R, Oyedokun T, Stempien J. Strength in the gap: A rapid review of principles and practices for urgent care centres. Healthc Manage Forum 2023; 36:101-106. [PMID: 36519425 PMCID: PMC9976643 DOI: 10.1177/08404704221143300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Responding to a provincial government decision to develop two Urgent Care Centres (UCCs) in Saskatchewan, we undertook a rapid review of published literature with the objective of determining best practices for their creation and functioning. Two English-limited PubMed database searches combining "after-hours care," "ambulatory care," "emergency medicine," "urgent care," "minor emergency," "walk-in," and "Canada" over the past 10 years were the sources of articles for our review. Articles were independently reviewed by two authors and synthesized collaboratively. From 833 articles, 44 were utilized in the review. Six considerations in the following areas were subsequently outlined: expected impact, preferred location, healthcare services collaboration, available services, staffing priorities, and community partnerships. These principles were considered against the backdrop of currently successful Canadian UCCs. This review indicates that general principles for the successful development of UCCs exist; these may guide the establishment and functioning of UCCs both in Saskatchewan and elsewhere.
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Affiliation(s)
- Ponn Benjamin
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Rhonda Bryce
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Rhonda Bryce, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. E-mail:
| | | | - James Stempien
- Royal University Hospital, Saskatoon, Saskatchewan, Canada
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Liedes-Kauppila M, Heikkinen AM, Rahkonen O, Lehto M, Mustonen K, Raina M, Kauppila T. Development of the use of primary health care emergency departments after interventions aimed at decreasing overcrowding: a longitudinal follow-up study. BMC Emerg Med 2022; 22:108. [PMID: 35701736 PMCID: PMC9195435 DOI: 10.1186/s12873-022-00667-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study, conducted in a Finnish city, examined whether decreasing emergency department (ED) services in an overcrowded primary care ED and corresponding direction to office-hours primary care would modify service usage for specific gender, age or diagnosis groups. Methods This was an observational retrospective study carried out by gradually decreasing ED services in primary care. The interventions aimed at decreasing use of EDs were a) application of ABCDE-triage combined with public guidance on the proper use of EDs, b) closure of a minor supplementary ED, and finally, c) application of “reverse triage” with enhanced direction of the public to office-hours services and away from the remaining ED The annual number of visits to office-hours primary care GPs in different gender, age and diagnosis groups (International Classification of Diseases (ICD − 10) were recorded during a 13-year follow-up period. Results The total number of monthly visits to EDs decreased slowly over the whole study period. This decrease was similar in women and men. The decrease was stronger in the youngest age groups (0–19 years). GPs treated decreasing proportions of ICD-10 groups. Recorded infectious diseases (Groups A and J, and especially diagnoses related to infections of respiratory airways) tended to decrease. However, visits due to injuries and symptomatic diagnoses increased. Conclusion Decreasing services in a primary health care ED with the described interventions seemed to reduce the use of services by young people. The three interventions mentioned above had the effect of making the primary care ED under study appear to function more like a standard ED driven by specialized health care.
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Affiliation(s)
- Marja Liedes-Kauppila
- Department of Public Health, University of Helsinki, Finland, Biomedicum 2, Tukholmankatu 8 B, SF-00014 Helsingin yliopisto, Helsinki, Finland
| | - Anna M Heikkinen
- Department of Public Health, University of Helsinki, Finland, Biomedicum 2, Tukholmankatu 8 B, SF-00014 Helsingin yliopisto, Helsinki, Finland.,Department of Oral and Maxillofacial Diseases, Head and Neck Center, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Finland, Biomedicum 2, Tukholmankatu 8 B, SF-00014 Helsingin yliopisto, Helsinki, Finland
| | - Mika Lehto
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Vantaa Health Centre, Vantaa, Finland
| | - Katri Mustonen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Timo Kauppila
- Department of Public Health, University of Helsinki, Finland, Biomedicum 2, Tukholmankatu 8 B, SF-00014 Helsingin yliopisto, Helsinki, Finland.
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Midtbø V, Fotland SLS, Johansen IH, Hunskaar S. From direct attendance to telephone triage in an emergency primary healthcare service: an observational study. BMJ Open 2022; 12:e054046. [PMID: 35501086 PMCID: PMC9062791 DOI: 10.1136/bmjopen-2021-054046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To describe how an intervention to limit direct attendance in an emergency primary healthcare service affected the contacts to the clinic and the level of care given, and which factors were associated with a change from direct attendance to telephone contact. DESIGN Observational study. SETTING Seven Norwegian emergency primary healthcare services. The telephone triage operators are primarily registered nurses. PARTICIPANTS Registered patient contacts to the services during 2007-2019. INTERVENTIONS In 2013, one of the seven services made an intervention to limit direct attendances to the emergency primary healthcare clinic. Through an advertisement in a local newspaper, the public was encouraged to call in advance. Patients who still attended directly, were encouraged to call in advance next time. MEASURES We compared the proportions of direct attendance and telephone contact, and of consultation by a general practitioner and telephone consultation by an operator, before and after the intervention. We also compared the proportions of direct attendance regarding gender, age group, time of day and urgency level. Descriptive analyses and log binomial regression analyses were applied. RESULTS There were 1 105 019 contacts to the seven services during the study period. The average proportion of direct attendance decreased from 68.7% (95% CI 68.4% to 68.9%) to 23.4% (95% CI 23.2% to 23.6%) in the service that carried out the intervention. Telephone consultation by an operator increased from 11.7% (95% CI 11.5% to 11.8%) to 29.2% (95% CI 28.9% to 29.5%) and medical consultation by a general practitioner decreased from 78.3% (95% CI 78.1% to 78.5%) to 57.0% (95% CI 56.7% to 57.3%). The youngest and the oldest age group and women had the largest decrease in direct attendance, by -81%, -74% and -71%, respectively. CONCLUSION The intervention influenced how the public contacted the service. Information campaigns on how to contact healthcare services should be implemented on a regular basis.
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Affiliation(s)
- Vivian Midtbø
- NORCE Health, NORCE Norwegian Research Centre AS, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | - Siri-Linn Schmidt Fotland
- NORCE Health, NORCE Norwegian Research Centre AS, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | | | - Steinar Hunskaar
- NORCE Health, NORCE Norwegian Research Centre AS, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
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Henricson J, Ekelund U, Hartman J, Ziegler B, Kurland L, Björk Wilhelms D. Pathways to the emergency department - a national, cross-sectional study in Sweden. BMC Emerg Med 2022; 22:58. [PMID: 35392826 PMCID: PMC8991881 DOI: 10.1186/s12873-022-00619-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Swedish Emergency Departments (EDs) see 2.6 million visits annually. Sweden has a strong tradition of health care databases, but information on patients’ pathways to the ED is not documented in any registry. The aim of this study was to provide a national overview of pathways, degree of medical acuteness according to triage, chief complaints, and hospital admission rates for adult patients (≥18 years) visiting Swedish EDs during 24 h. Methods A national cross-sectional study including all patients at 43 of Sweden’s 72 EDs during 24 h on April 25th, 2018. Pathway to the ED, medical acuteness at triage, admission and basic demographics were registered by dedicated assessors present at every ED for the duration of the study. Descriptive data are reported. Results A total of 3875 adult patients (median age 59; range 18 to 107; 50% men) were included in the study. Complete data for pathway to the ED was reported for 3693 patients (98%). The most common pathway was self-referred walk-in (n = 1310; 34%), followed by ambulance (n = 920; 24%), referral from a general practitioner (n = 497; 1 3%), and telephone referral by the national medical helpline “1177” (n = 409; 10%). In patients 18 to 64 years, self-referred walk-in was most common, whereas transport by ambulance dominated in patients > 64 years. Of the 3365 patients who received a medical acuteness level at triage, 4% were classified as Red (Immediate), 18% as Orange (very urgent), 47% as Yellow (Urgent), 26% as Green (Standard), and 5% as Blue (Non-Urgent). Abdominal or chest pain were the most common chief complaints representing approximately 1/3 of all presentations. Overall, the admission rate was 27%. Arrival by ambulance was associated with the highest rate of admission (53%), whereas walk-in patients and telephone referrals were less often admitted. Conclusion Self-referred walk-in was the overall most common pathway followed by ambulance. Patients arriving by ambulance were often elderly, critically ill and often admitted to in-patient care, whereas arrival by self-referred walk-in was more common in younger patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00619-3.
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Affiliation(s)
- Joakim Henricson
- Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden. .,Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Region Östergötland, SE-58185, Linköping, Sweden.
| | - Ulf Ekelund
- Department of Emergency Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Jens Hartman
- Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Bruno Ziegler
- Department of Emergency Medicine Örebro University Hospital, Örebro University, Örebro, Sweden
| | - Lisa Kurland
- Department of Emergency Medicine Örebro University Hospital, Örebro University, Örebro, Sweden
| | - Daniel Björk Wilhelms
- Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Region Östergötland, SE-58185, Linköping, Sweden.,Division of Drug Research, Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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Brasseur E, Gilbert A, Servotte JC, Donneau AF, D’Orio V, Ghuysen A. Emergency department crowding: why do patients walk-in? Acta Clin Belg 2021; 76:217-223. [PMID: 31886742 DOI: 10.1080/17843286.2019.1710040] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: For years, general practitioners (GP) shortage and patients' increasing demand for acute care have been associated with Emergency Department (ED) crowding. Indeed, EDs admissions for non-emergency care seem to constantly increase. Surprisingly, the rationale for patients own decision to directly reach EDs over primary care have been poorly investigated to date.Methods: We conducted a study on patients admitted in two University EDs during nine consecutive days. Patients were asked to answer a survey about their frames for coming and if they were self-referred, referred by a GP, a specialist or after calling the Emergency Number.Results: During the study period, 68.0% of patients were self-referred, 17.0% referred by their GP, 8.5% by a specialist and 7% after an emergency call. 51.0% of the self-referrals thought EDs were the appropriate location to deal with their health problem and 24.0% because of a better accessibility. We noticed that 15.0% of the incomings looked for specialized care and 4.22% reported that the stress had motivated them. Of note, 4.6% of the patients were attracted by the hospital reputation. Financial concerns represented less than 1.0% of the motives invocated.Conclusion: We found that patients' self-perceived severity of illness is the predominant frame to each the ED when they face needs for acute care. EDs' accessibility as compared with other facilities also seems to encourage patients to come to the ED. Other factors such as the hospital reputation or patients' stress tend to influence ED attendance but to a much lesser extent.
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Affiliation(s)
- Edmond Brasseur
- Emergency Department, Liege University Hospital Centre, Liège, Belgium
| | - Allison Gilbert
- Emergency Department, Liege University Hospital Centre, Liège, Belgium
| | | | | | - Vincent D’Orio
- Emergency Department, Liege University Hospital Centre, Liège, Belgium
- Medicine Faculty, University of Liege, Liège, Belgium
| | - Alexandre Ghuysen
- Emergency Department, Liege University Hospital Centre, Liège, Belgium
- Departement of Public Health, University of Liège, Liège, Belgium
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Mashao K, Heyns T, White Z. Areas of delay related to prolonged length of stay in an emergency department of an academic hospital in South Africa. Afr J Emerg Med 2021; 11:237-241. [PMID: 33747758 PMCID: PMC7966966 DOI: 10.1016/j.afjem.2021.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/20/2020] [Accepted: 02/01/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Globally, length of stay of patients in emergency departments remains a challenge. Remaining in the emergency department for >12 h increases health care costs, morbidity and mortality rates and leads to crowding and lower patient satisfaction.The aim of this research was to describe the areas of delay related to prolonged length of stay in the emergency department of an academic hospital. Methods A quantitative retrospective study was done. The Input-Throughput-Output model was used to identify the areas of patients' journey through the emergency department. The possible areas of delay where then described. Using systematic sampling, a total of 100 patient files managed in an emergency department of an academic hospital in South Africa were audited over a period of 3 months. Descriptive statistics and regression analysis was used to analyse data. Results The mean length of stay of patients in the emergency department was 73 h 49 min. The length of stay per phase was: input (3 h 17 min), throughput (16 h 25 min) and output (54 h 7 min). A strong significant relationship found between the length of stay and the time taken between disposition decision (throughput phase) disposition decision to admission or discharge of patients from the ED (output phase) (p < 0.05). Conclusion The output phase was identified as the longest area of delay in this study, with the time taken between disposition decision to admission or discharge of patients from the ED (patients waiting for inpatient beds) as the main significant area of delay.
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Affiliation(s)
- Kapari Mashao
- University of Pretoria, Department of Nursing Science, Pretoria, South Africa
| | - Tanya Heyns
- University of Pretoria, Department of Nursing Science, Pretoria, South Africa
| | - Zelda White
- University of Pretoria, Department of Human Nutrition, Pretoria, South Africa
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Schoenmakers B, Van Criekinge J, Boeve T, Wilms J, Van Der Mullen C, Sabbe M. Co-location of out of hours primary care and emergency department in Belgium: patients' and physicians' view. BMC Health Serv Res 2021; 21:282. [PMID: 33771152 PMCID: PMC7995743 DOI: 10.1186/s12913-021-06281-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/15/2021] [Indexed: 11/27/2022] Open
Abstract
Background In Belgium, General Practitioner Cooperatives (GPC) aim to improve working conditions for unplanned care and to reduce the number of low acuity emergency visits. Although this system is well organized, the number of low acuity visits does not decrease. Methods We explored the view of patients and physicians on the co-location of a GPC and an emergency service for unplanned care. The study was carried out in a cross section design in primary and emergency care services and included patients and physicians. Main outcome measure was the view of patients and physician on co-location of a GPC and an emergency service. Results 404 patients and 488 physicians participated. 334 (82.7%) of all patients favoured a co-location. The major advantages were fast service (104, 25.7) and adequate referral (54, 13.4%). 237 (74%) of the GPs and 38 (95%) of the emergency physicians were in favour of a co-location. The major advantage was a more adequate referral of patients. 254 (79%) of the GPs and 23 (83%) of the emergency physicians believed that a co-location would lower the workload and waiting time and increase care quality (resp. 251 (78%), 224 (70%) and 37 (93%), 34 (85%). Conclusions To close the expectation gap between GP’s, emergency physicians and to reach for high care quality, information campaigns and development of workflows are indispensable for a successful implementation of a co-location of primary and emergency care.
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Affiliation(s)
- Birgitte Schoenmakers
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 box 7001, 3000, Leuven, Belgium.
| | - Jasper Van Criekinge
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 box 7001, 3000, Leuven, Belgium
| | - Timon Boeve
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 box 7001, 3000, Leuven, Belgium
| | - Jonas Wilms
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 box 7001, 3000, Leuven, Belgium
| | - Chris Van Der Mullen
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 box 7001, 3000, Leuven, Belgium
| | - Marc Sabbe
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 box 7001, 3000, Leuven, Belgium
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Höglinger M, Knöfler F, Schaumann-von Stosch R, Scholz-Odermatt SM, Eichler K. Recent trends and variations in general practitioners' involvement in accident care in Switzerland: an analysis of claims data. BMC FAMILY PRACTICE 2020; 21:99. [PMID: 32503550 PMCID: PMC7275559 DOI: 10.1186/s12875-020-01170-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022]
Abstract
Background As in other countries, there is concern and some fragmentary evidence that GPs’ central role in the Swiss healthcare system as the primary provider of care might be changing or even be in decline. Our study gives a systematic account of GPs’ involvement in accident care from 2008 to 2016 and identifies changes in GPs’ involvement in this typical field of primary care: how frequently GPs were involved along the care pathway, to what extent they figured as initial care provider, and what their role in the care pathway was. Methods Using a claims dataset from the largest Swiss accident insurer with two million accident cases, we constructed individual care pathways, i.e., when and from which providers patients received care. We calculated probabilities for the involvement of various care provider groups, for initial care provision, and for the role of GPs in patients’ care pathways, adjusted for injury and patient characteristics using multinomial regression. Results In 2014, GPs were involved in 70% of all accident cases requiring outpatient care but no inpatient stay, and provided initial care in 56%. While involvement stayed at about the same level for accidents occurring from 2008 to 2014, the share of accidents where GPs provided initial care decreased by 4 percentage points. The share of cases where GPs acted as sole care provider decreased by 7 percentage points down to 44%. At the same time, accident cases involving care from an ED at any point in time increased from 38 to 46% and the share receiving initial care from an ED from 30 to 35 percentage points – apparently substituting for the declining involvement of GPs in initial care. GPs’ involvement in accident care is higher in rural compared to urban regions, among elderly compared to younger patients, and among Swiss compared to non-Swiss citizens. Conclusions GPs play a key role in accident care with considerable variation depending on region and patient profile. From 2008 to 2014, there is a remarkable decline in GPs’ provision of initial care after an accident. This is a strong indication that the GPs’ role in the Swiss healthcare system is changing.
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Affiliation(s)
- Marc Höglinger
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401, Winterthur, Switzerland.
| | - Fabio Knöfler
- XUND - Bildungszentrum Gesundheit Zentralschweiz, Alpnach, Switzerland
| | - Rita Schaumann-von Stosch
- SUVA - Swiss National Accident Insurance Fund, Lucerne, Switzerland.,SGTV - Swiss Association for Traumatology and Insurance Medicine, Bern, Switzerland
| | | | - Klaus Eichler
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401, Winterthur, Switzerland
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Foster H, Moffat KR, Burns N, Gannon M, Macdonald S, O'Donnell CA. What do we know about demand, use and outcomes in primary care out-of-hours services? A systematic scoping review of international literature. BMJ Open 2020; 10:e033481. [PMID: 31959608 PMCID: PMC7045150 DOI: 10.1136/bmjopen-2019-033481] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To synthesise international evidence for demand, use and outcomes of primary care out-of-hours health services (OOHS). DESIGN Systematic scoping review. DATA SOURCES CINAHL; Medline; PsyARTICLES; PsycINFO; SocINDEX; and Embase from 1995 to 2019. STUDY SELECTION English language studies in UK or similar international settings, focused on services in or directly impacting primary care. RESULTS 105 studies included: 54% from mainland Europe/Republic of Ireland; 37% from UK. Most focused on general practitioner-led out-of-hours cooperatives. Evidence for increasing patient demand over time was weak due to data heterogeneity, infrequent reporting of population denominators and little adjustment for population sociodemographics. There was consistent evidence of higher OOHS use in the evening compared with overnight, at weekends and by certain groups (children aged <5, adults aged >65, women, those from socioeconomically deprived areas, with chronic diseases or mental health problems). Contact with OOHS was driven by problems perceived as urgent by patients. Respiratory, musculoskeletal, skin and abdominal symptoms were the most common reasons for contact in adults; fever and gastrointestinal symptoms were the most common in the under-5s. Frequent users of daytime services were also frequent OOHS users; difficulty accessing daytime services was also associated with OOHS use. There is some evidence to suggest that OOHS colocated in emergency departments (ED) can reduce demand in EDs. CONCLUSIONS Policy changes have impacted on OOHS over the past two decades. While there are generalisable lessons, a lack of comparable data makes it difficult to judge how demand has changed over time. Agreement on collection of OOHS data would allow robust comparisons within and across countries and across new models of care. Future developments in OOHS should also pay more attention to the relationship with daytime primary care and other services. PROSPERO REGISTRATION NUMBER CRD42015029741.
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Affiliation(s)
- Hamish Foster
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Keith R Moffat
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Nicola Burns
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Maria Gannon
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Sara Macdonald
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
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Krämer J, Schreyögg J. Substituting emergency services: primary care vs. hospital care. Health Policy 2019; 123:1053-1060. [PMID: 31500837 DOI: 10.1016/j.healthpol.2019.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 05/30/2019] [Accepted: 08/16/2019] [Indexed: 11/29/2022]
Abstract
Overcrowding in emergency departments (EDs) is inefficient, especially if it is caused by inappropriate visits for which primary care physicians could be equally effective as a hospital ED. Our paper investigates the extent to which both ambulatory ED visits and inpatient ED admissions are substitutes for primary care emergency services (PCES) in Germany. We use extensive longitudinal data and fixed effects models. Moreover, we add interaction terms to investigate the influence of various determinants on the strength of the substitution. Our results show significant substitution between PCES and ambulatory ED visits. Regarding the determinants, we find the largest substitution for younger patients. The more accessible the hospital ED is, the significantly larger the substitution. Moreover, substitution is larger among better-educated patients. For inpatient ED admission, we find significant substitution that is eight times smaller than the substitution for ambulatory ED visits. With regard to the determinants, we find the strongest substitution for non-urgent, short-stay admission and elderly patients. Countries with no gate-keeping system (such as Germany) have difficulties redirecting the patients streaming to EDs. Our estimated elasticities can help policy makers to resolve this issue, as our findings indicate where incentivizing the utilization of PCES is particularly effective.
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Affiliation(s)
- Jonas Krämer
- Hamburg Centre for Health Economics, Universität Hamburg, 20354 Hamburg, Germany.
| | - Jonas Schreyögg
- Hamburg Centre for Health Economics, Universität Hamburg, 20354 Hamburg, Germany.
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Henninger S, Spencer B, Pasche O. Deciding whether to consult the GP or an emergency department: A qualitative study of patient reasoning in Switzerland. Eur J Gen Pract 2019; 25:136-142. [PMID: 31272245 PMCID: PMC6713128 DOI: 10.1080/13814788.2019.1634688] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Non-urgent care is an important factor responsible for rising healthcare costs and general practitioners (GPs) are known to be more cost-effective than emergency departments (EDs). Objectives: To understand the reasons why patients confronted with a medical problem perceived as urgent choose to consult either a GP or an ED. Methods: We conducted a qualitative study in Switzerland, using data collected between 2014 and 2015 through semi-structured interviews of adults with non-vital medical problems. Half were recruited after an ambulatory consultation in an ED, and half were patients who consulted their GP. The audio-recorded interviews were transcribed, coded, and analysed according to the constant comparative method. Results: The main reason given by patients who consulted their GP first was the quality of the relationship. The more meaningful the relationship, the more likely patients were to seek advice from their GP. One marker of a privileged relationship was GPs supplying their mobile phone number to the patient. The perceived nature of the complaint, for example, symptoms considered as life-threatening or severe pain, together with the expected waiting time in an ED were additional factors influencing the patients’ choice. Conclusion: Our study showed that when patients are confronted with what they perceive as a medical emergency, the quality of the relationship with the GP, in particular the continuity of care provided, seem to be the major reasons why they consult their GP rather than an ED.
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Affiliation(s)
| | - Brenda Spencer
- b Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital , Lausanne , Switzerland
| | - Olivier Pasche
- a ForOm Nord Vaudois , Yverdon , Switzerland.,c Department of Ambulatory Care and Community Medicine, University of Lausanne , Lausanne , Switzerland
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Bösner S, Abushi J, Feufel M, Donner-Banzhoff N. Diagnostic strategies in general practice and the emergency department: a comparative qualitative analysis. BMJ Open 2019; 9:e026222. [PMID: 31154305 PMCID: PMC6549708 DOI: 10.1136/bmjopen-2018-026222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 02/19/2019] [Accepted: 04/04/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We sought to explore differences and commonalities between diagnostic strategies used by clinicians in general practice and the emergency department. DESIGN Qualitative study. SETTINGS We videotaped 282 consultations of 12 general practitioners (GPs) in Germany, irrespective of presenting complaint or final diagnosis. Reflective interviews were performed after each consultation. In addition, 171 consultations of 16 emergency physicians (EPs) based at two tertiary care hospitals in the Midwest of the USA were observed, and their conversations recorded. Recordings of consultations and GP interviews were transcribed verbatim and analysed using a coding system that was based on published literature and systematically checked for reliability. RESULTS EPs more often considered acute and severe conditions, even if pretest probabilities were low. In contrast, GPs more often involved their patients in the decision-making process and provided assurance concerning their complaints. To focus their workup, EPs used a more directive style of interviewing including a high proportion of routine questions and rarely used open questions or active listening. CONCLUSIONS Strategies used by physicians in both settings seem to be well adapted to their respective environments. Whereas the physician-led diagnostic process in the emergency department is well suited to rule out life-threating disease, diagnosis and appropriate treatment of everyday problems may require a more patient-centred style.
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Affiliation(s)
- Stefan Bösner
- Department of General Practice/Family Medicine, Philipps University of Marburg, Marburg, Germany
| | - Jamal Abushi
- Department of General Practice/Family Medicine, Philipps University of Marburg, Marburg, Germany
| | - Markus Feufel
- Department of Psychology and Ergonomics, Division of Ergonomics, Technische Universitat Berlin, Berlin, Germany
| | - Norbert Donner-Banzhoff
- Department of General Practice/Family Medicine, Philipps University of Marburg, Marburg, Germany
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Cooper A, Davies F, Edwards M, Anderson P, Carson-Stevens A, Cooke MW, Donaldson L, Dale J, Evans BA, Hibbert PD, Hughes TC, Porter A, Rainer T, Siriwardena A, Snooks H, Edwards A. The impact of general practitioners working in or alongside emergency departments: a rapid realist review. BMJ Open 2019; 9:e024501. [PMID: 30975667 PMCID: PMC6500276 DOI: 10.1136/bmjopen-2018-024501] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 12/14/2018] [Accepted: 01/24/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Worldwide, emergency healthcare systems are under intense pressure from ever-increasing demand and evidence is urgently needed to understand how this can be safely managed. An estimated 10%-43% of emergency department patients could be treated by primary care services. In England, this has led to a policy proposal and £100 million of funding (US$130 million), for emergency departments to stream appropriate patients to a co-located primary care facility so they are 'free to care for the sickest patients'. However, the research evidence to support this initiative is weak. DESIGN Rapid realist literature review. SETTING Emergency departments. INCLUSION CRITERIA Articles describing general practitioners working in or alongside emergency departments. AIM To develop context-specific theories that explain how and why general practitioners working in or alongside emergency departments affect: patient flow; patient experience; patient safety and the wider healthcare system. RESULTS Ninety-six articles contributed data to theory development sourced from earlier systematic reviews, updated database searches (Medline, Embase, CINAHL, Cochrane DSR & CRCT, DARE, HTA Database, BSC, PsycINFO and SCOPUS) and citation tracking. We developed theories to explain: how staff interpret the streaming system; different roles general practitioners adopt in the emergency department setting (traditional, extended, gatekeeper or emergency clinician) and how these factors influence patient (experience and safety) and organisational (demand and cost-effectiveness) outcomes. CONCLUSIONS Multiple factors influence the effectiveness of emergency department streaming to general practitioners; caution is needed in embedding the policy until further research and evaluation are available. Service models that encourage the traditional general practitioner approach may have shorter process times for non-urgent patients; however, there is little evidence that this frees up emergency department staff to care for the sickest patients. Distinct primary care services offering increased patient choice may result in provider-induced demand. Economic evaluation and safety requires further research. PROSPERO REGISTRATION NUMBER CRD42017069741.
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Affiliation(s)
- Alison Cooper
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Freya Davies
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Michelle Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Pippa Anderson
- Centre for Health Economics, Swansea University, Swansea, UK
| | | | | | - Liam Donaldson
- London School of Hygiene and Tropical Medicine, London, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Peter D Hibbert
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
| | - Thomas C Hughes
- Emergency Department, John Radcliffe Hospital, Oxford, Oxfordshire, UK
| | - Alison Porter
- College of Medicine, Swansea University, Swansea, UK
| | - Tim Rainer
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | - Helen Snooks
- College of Medicine, Swansea University, Swansea, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
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Seeger I, Kreienmeyer L, Hoffmann F, Freitag MH. Cross-sectional study in an out-of-hours primary care centre in northwestern Germany - patient characteristics and the urgency of their treatment. BMC FAMILY PRACTICE 2019; 20:41. [PMID: 30836946 PMCID: PMC6399868 DOI: 10.1186/s12875-019-0929-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/26/2019] [Indexed: 11/20/2022]
Abstract
Background Due to the increasing number of non-urgent visits to emergency departments, it is becoming increasingly important to also investigate emergency care in out-of-hours (OOH) primary care. The aim of this study was to provide an insight into the care structures of an OOH primary care centre, to evaluate the reasons for encounter (RFE) and to assess the urgency of the treatment from the physicians´ point of view. Methods In the summer of 2017, we conducted a cross-sectional study over four weeks in the OOH primary care centre of Oldenburg, a city in Lower Saxony with about 160,000 inhabitants. We collected socio-demographic data, RFE and the duration of the complaints. The International Classification for Primary Care 2nd Edition (ICPC-2) was used to categorize symptoms. The attending physicians supplemented information on further treatment (including hospitalization) and the urgency of consultation in the OOH primary care centre. Results A total of 892 of the 1098 OOH patients which were visiting the OOH primary care centre took part in the study (participation: 81.2%). More than half of the patients were between 18 and 39 years old. A quarter of all RFE named by study participants were in the ICPC-2 category “skin”. More than 60% of patients had the symptoms for more than two days before visiting the OOH primary care centre. In 34.5% of all cases no medication was prescribed and one in six patients received further diagnostic tests such as urinalysis and blood tests (15.8%). From the physicians’ point of view, 26.3% of all study participants could have been treated by the family doctor during the regular consultation hours. Conclusion The study shows that in the OOH primary care centre about a quarter of all patients could have waited until regular consultation hours. Mostly young patients used the easily accessible and free care in the OOH primary care centre. Further studies are necessary to better understand the individual reasons of patients to use the OOH primary care centre.
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Affiliation(s)
- Insa Seeger
- Department for Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, D-26111, Oldenburg, Germany.
| | - Laura Kreienmeyer
- Department for Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, D-26111, Oldenburg, Germany
| | - Falk Hoffmann
- Department for Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, D-26111, Oldenburg, Germany
| | - Michael H Freitag
- Department for Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, D-26111, Oldenburg, Germany
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Huibers L, Keizer E, Carlsen AH, Moth G, Smits M, Senn O, Christensen MB. Help-seeking behaviour outside office hours in Denmark, the Netherlands and Switzerland: a questionnaire study exploring responses to hypothetical cases. BMJ Open 2018; 8:e019295. [PMID: 30341108 PMCID: PMC6196844 DOI: 10.1136/bmjopen-2017-019295] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 05/11/2018] [Accepted: 06/14/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We aim to study the preferred behaviour among individuals from different age groups in three countries when acute health problems occur outside office hours and thereby to explore variations in help-seeking behaviour. DESIGN A questionnaire study exploring responses to six hypothetical cases describing situations with a potential need for seeking medical care and questions on background characteristics. SETTING General population in Denmark, the Netherlands and Switzerland. POPULATION Danish, Dutch and Swiss individuals from three age groups (0-4, 30-39, 50-59 years). MAIN OUTCOME MEASURES Distribution of intended help-seeking preferences per case per age group, compared between countries. Differences in percentage of help-seeking outside office hours per age group and country, crude and adjusted for background characteristics. RESULTS Danish and Dutch parents of children aged 0-4 years differed in intended help-seeking behaviour for five out of six cases (abdominal pain, red eyes, rash, relapse fever, chickenpox); Danish parents significantly more often chose to contact out-of-hours (OOH) care than Dutch parents. For adults aged 30-39 years, no significant difference between the three countries was found for contacting OOH care. Swiss adults aged 50-59 years had the highest percentage of OOH contacts (38.3%), followed by the Danish (33.4%) and the Dutch (32.5%). CONCLUSION Some differences in help-seeking behaviour outside office hours exist between Danish, Dutch and Swiss individuals, particularly for parents of young children. The question remains whether these differences result from individual preferences, cultural disparities and/or health services variations. Future research should focus on identifying explanations for these differences to reduce undesirable use of OOH care.
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Affiliation(s)
| | - Ellen Keizer
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | | | - Grete Moth
- Research Unit for General Practice, Aarhus, Denmark
| | - Marleen Smits
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
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Riedl B, Kehrer S, Werner CU, Schneider A, Linde K. Do general practice patients with and without appointment differ? Cross-sectional study. BMC FAMILY PRACTICE 2018; 19:101. [PMID: 29935538 PMCID: PMC6015657 DOI: 10.1186/s12875-018-0787-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/31/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Even in practices with a comprehensive appointment system a minority of patients walks in without prior notice, sometimes causing problems for practice service quality. We aimed to explore differences between patients consulting primary care practices with and without appointment. METHODS Consecutive patients visiting five primary care practices without an appointment and following patients with an appointment were asked to fill in a four-page questionnaire addressing socio-demographic characteristics, the reason for encounter, urgency of seeing a physician, depressive, somatic and anxiety symptoms, personality traits, and satisfaction with the practice. Physicians also documented the reason for encounter and assessed the urgency. Data were analyzed using univariate and multivariate methods. RESULTS Two hundred fifty-one patients without and 250 patients with appointment participated. Patients without appointment were significantly younger (mean age 44 vs. 50 years) and reported less often chronic diseases (29% vs. 45%). Also, reasons for encounter differed (e.g., 27% vs. 16% with a respiratory problem). Patients' ratings of urgency did not differ between groups (p = 0.46), but physicians rated urgency higher among patients without appointment (p < 0.001). In logistic regression analyses younger age, male gender, absence of chronic disease, positive screening for at least one mental disorder, low values on the personality trait openness for experience, a high urgency rating by the physician, and a respiratory or musculoskeletal problem as reason for encounter were significantly associated with a higher likelihood of being a patient without appointment. CONCLUSIONS In this study, younger age and a high urgency rating by physicians were the variables most consistently associated with the likelihood of being a patient without appointment. Overall, differences between patients seeking general practices with a comprehensive appointment system without prior notice and patients with appointments were relatively minor.
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Affiliation(s)
- Bernhard Riedl
- Technical University of Munich, TUM School of Medicine, Institute of General Practice, Orleansstrasse 47, 81667 Munich, Germany
| | - Simon Kehrer
- Technical University of Munich, TUM School of Medicine, Institute of General Practice, Orleansstrasse 47, 81667 Munich, Germany
| | - Christoph U. Werner
- Technical University of Munich, TUM School of Medicine, Institute of General Practice, Orleansstrasse 47, 81667 Munich, Germany
| | - Antonius Schneider
- Technical University of Munich, TUM School of Medicine, Institute of General Practice, Orleansstrasse 47, 81667 Munich, Germany
| | - Klaus Linde
- Technical University of Munich, TUM School of Medicine, Institute of General Practice, Orleansstrasse 47, 81667 Munich, Germany
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Leutgeb R, Frankenhauser-Mannuß J, Scheuer M, Szecsenyi J, Goetz K. Job satisfaction and stressors for working in out-of-hours care - a pilot study with general practitioners in a rural area of Germany. BMC FAMILY PRACTICE 2018; 19:95. [PMID: 29933743 PMCID: PMC6015473 DOI: 10.1186/s12875-018-0777-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 05/25/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Challenging work environment, high workload, and increasing physician shortages characterize current rural general practice in Germany and in most European Countries. These factors extend into Out-Of-Hours Care (OOHC). However, little research about potential stressors for general practitioners (GPs) in OOHC settings is available. This pilot study aimed to evaluate workload, different elements of job satisfaction and stressors for GPs in OOHC and to analyze whether these aspects are associated with overall job satisfaction. METHODS Cross-sectional survey with a sample of 320 GPs who are working in OOHC was used to measure workload in OOHC, job satisfaction (using the Warr-Cook-Wall scale) and stressors with the effort-reward imbalance questionnaire. In order to assess associations between workload, job satisfaction and stressors at work we performed descriptive analyses as well as multivariable regression analyses. RESULTS The response rate was 40.9%. Over 80% agreed that OOHC was perceived as a stressor and 79% agreed that less OOHC improved job satisfaction. Only 42% of our sample were satisfied with their overall job satisfaction. The regression analysis showed that the modification of current OOHC organization was significantly associated with overall job satisfaction. CONCLUSIONS Our results suggest that OOHC in the current form is a relevant stressor in daily work of rural GPs in Germany and one of the reasons for a decreasing overall job satisfaction. Strategic changes such as the implementation of structural reforms e.g. reducing frequency of OOHC duties for each GP and improving continuing professional development options related to OOHC are needed to address current workload challenges experienced by GPs providing OOHC in Germany.
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Affiliation(s)
- R Leutgeb
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius-Arcades, Western Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - J Frankenhauser-Mannuß
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius-Arcades, Western Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - M Scheuer
- Headquarter of Control Centre, District Bergstraße, Gräffstrasse 5, 64646, Heppenheim, Germany
| | - J Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius-Arcades, Western Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Katja Goetz
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius-Arcades, Western Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.,Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Alle 160, 23538, Luebeck, Germany
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Storr C, Gahbler LM, Linde K, Schneider A. Reasons for encounters and psychiatric comorbidity in an urban Bavarian primary care out-of-hour service - results of a cross sectional study. BMC Health Serv Res 2017; 17:783. [PMID: 29183310 PMCID: PMC5704587 DOI: 10.1186/s12913-017-2749-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 11/21/2017] [Indexed: 11/22/2022] Open
Abstract
Background International studies have shown a contribution of psychiatric comorbidity to high utilization rates in out-of-hour primary care (OOHC). Up to now, the impact of psychiatric comorbidity in German OOHC remains unclear. Therefore, we aimed to investigate reasons for encounter (RFE), possible psychiatric comorbidity, utilization rates, and a possible association between utilization rate and psychiatric comorbidity among patients of an urban OOHC unit. Methods In a cross-sectional, prospective, naturalistic study five hundred self-referred patients completed a self-designed questionnaire addressing RFE, past office visits and personal information. Additionally, we employed three validated questionnaires (PHQ-9, PHQ-15 and GAD-7) to screen for mental disorders. We collected information about past visits through computerized patients’ charts. Diagnoses were classified according to the International Classification of Primary Care-2. Results The most frequent RFE were musculoskeletal complaints (36%), followed by respiratory diseases (13%), gastrointestinal problems (10%), skin conditions (8%) and urologic ailments (6%). Of the included patients 58% were working fulltime and 61% had greater than or equal to 10 years of education. The mean age was 37.3 in females and 40.5 years in males. Prevalence of psychiatric comorbidity was 27%. Only 3% visited the office more than twice over a 12 months period. We could not find an association between high utilization and psychiatric comorbidity. Conclusion In this study, musculoskeletal complaints were the most frequent RFE. Patients were predominantly young, employed and educated. The prevalence of psychiatric comorbidity was similar to the prevalence in common general practitioner offices and showed no significant relation to frequent attendance. This information might help to prepare physicians better for patient care in OOHC.
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Affiliation(s)
- Constanze Storr
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Orleansstr. 47, 81667, Munich, Germany.
| | - Lucia Marieke Gahbler
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Orleansstr. 47, 81667, Munich, Germany
| | - Klaus Linde
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Orleansstr. 47, 81667, Munich, Germany
| | - Antonius Schneider
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Orleansstr. 47, 81667, Munich, Germany
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Out of hours care in Germany - High utilization by adult patients with minor ailments? BMC FAMILY PRACTICE 2017; 18:42. [PMID: 28327082 PMCID: PMC5361861 DOI: 10.1186/s12875-017-0609-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 01/05/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Family practitioners (FPs) who work in Out-Of-Hours Care (OOHC) - especially in rural areas - complain about high workload related to low urgency and potentially unnecessary patient presentations with minor ailments. The aim of this study was to describe Reasons for Encounter (RFEs) in primary OOHC taken into account the doctor's perspective in the context of high workload without knowing patients' motives for visiting an OOHC-centre. METHODS Within this descriptive study, OOHC data from 2012 were evaluated from a German statutory health insurance company in the federal state of Baden-Wuerttemberg. 1.53 Million of the 10.5 Million inhabitants of Baden-Wuerttemberg were covered. The frequency of the ICD-10 diagnoses was determined at the three- and four-digit-level. The rate of hospitalizations was used to estimate the severity of the evaluated cases. RESULTS Taken as a whole, 163,711 reasons for encounter with 1,174 ICD-10 single diagnoses were documented, of these 62.2% were on weekends. Less than 5.0% of the examined patients were hospitalized. Low back pain-dorsalgia (M54) was the most common diagnosis in OOHC, with 10,843 cases. Injuries were found twelve times in the list of the 30 most frequent diagnoses. The most frequent infectious disease was acute upper respiratory infection of multiple and unspecified sites (J06). By analysing the ICD codes to four-digits and looking at the rate of hospitalizations, it can be assumed that many RFEs were of less urgency in terms of the prompt need for medical treatment. CONCLUSION While it is acknowledged that it can be difficult to make an exact diagnosis in an OOHC setting, after analysing the ICD-10 diagnoses, the majority of reasons for encounter in OOHC were determined to be of low urgency, meaning that patients could have waited until regular consultation hours. In the OOHC setting, it is important to understand RFEs from both the patient perspective and the family practitioner perspective. Additionally, results like these can be used in staff education especially improving triage methods and medical recommendations and in developing specific guidelines for OOHC in Germany. Analysis of routine data, such as in this study, contributes to this understanding and contributes to resolving problems of coding.
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Scapinello MP, Posocco A, De Ronch I, Castrogiovanni F, Lollo G, Sergi G, Tomaselli I, Tonon L, Solmi M, Traversa S, Zambianco V, Veronese N. Predictors of emergency department referral in patients using out-of-hours primary care services. Health Policy 2016; 120:1001-7. [PMID: 27522452 DOI: 10.1016/j.healthpol.2016.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 07/21/2016] [Accepted: 07/25/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Out of hours (OOH) doctors could manage many cases limiting the inappropriate accesses to ED. However the possible determinants of referral to ED by OOH doctors are poorly studied. We aimed to characterize patients referred from the OOH to ED service in order to explore the gate-keeping role of OOH service for hospital emergency care and to facilitate future research in improving its cost-effectiveness. METHODS A retrospective study was made through data collection of 5217 contacts in a local OOH service in the North-East of Italy (from 10/01/2012 to 03/31/2013). RESULTS Only 8.7% (=454 people) of the total contacts were referred to ED. In the multivariate analysis, the significant predictors of being sent to ED were: age; residence in nursing home (odds ratios (OR)=2.00, 95%CI: 1.30-3.10); being visited by a OOH physician (OR=2.64, 95%CI: 2.09-3.34). Taking infections as reference, cardiovascular diseases (OR=18.31, 95%CI: 12.01-27.90), traumas (OR=8.75, 95%CI: 5.36-14.26) and gastrointestinal conditions (OR=7.69, 95%CI: 4.70-11.91) increased the probability to be referred to ED. CONCLUSIONS OOH service addresses several common medical conditions in community-dwelling and in nursing home context, supporting its filtering function for the ED access. The main reasons of ED access could be a crucial aspect in general population education in order to avoid the overcrowding of the ED.
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Affiliation(s)
- Maria Paola Scapinello
- Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy
| | - Andrea Posocco
- Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy; Scuola di Formazione Specifica in Medicina Generale, Regione Veneto, Venice, Italy
| | - Irene De Ronch
- Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy
| | - Francesco Castrogiovanni
- Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy
| | - Gianluca Lollo
- Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy
| | - Guglielmo Sergi
- Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy
| | - Iginio Tomaselli
- Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy
| | - Loris Tonon
- Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy; Unità Locale Socio Sanitaria 17, Monselice, Italy; Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy
| | - Stefano Traversa
- Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy
| | - Vincenzo Zambianco
- Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy
| | - Nicola Veronese
- Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy; University of Padova, Department of Medicine, Geriatrics Section, Italy; Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy.
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Hess S, Sidler P, Chmiel C, Bögli K, Senn O, Eichler K. Satisfaction of health professionals after implementation of a primary care hospital emergency centre in Switzerland: A prospective before–after study. Int Emerg Nurs 2015; 23:286-93. [DOI: 10.1016/j.ienj.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
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Read JG, Varughese S, Cameron PA. Determinants of non-urgent Emergency Department attendance among females in Qatar. Qatar Med J 2014; 2014:98-105. [PMID: 25745599 PMCID: PMC4344983 DOI: 10.5339/qmj.2014.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/10/2014] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The use of emergency department (ED) services for non-urgent conditions is well-studied in many Western countries but much less so in the Middle East and Gulf region. While the consequences are universal-a drain on ED resources and poor patient outcomes-the causes and solutions are likely to be region and country specific. Unique social and economic circumstances also create gender-specific motivations for patient attendance. Alleviating demand on ED services requires understanding these circumstances, as past studies have shown. We undertook this study to understand why female patients with low-acuity conditions choose the emergency department in Qatar over other healthcare options. SETTING AND DESIGN Prospective study at Hamad General Hospital's (HGH) emergency department female "see-and-treat" unit that treats low-acuity cases. One hundred female patients were purposively recruited to participate in the study. Three trained physicians conducted semi-structured interviews with patients over a three-month period after they had been treated and given informed consent. RESULTS The study found that motivations for ED attendance were systematically influenced by employment status as an expatriate worker. Forty percent of the sample had been directed to the ED by their employers, and the vast majority (89%) of this group cited employer preference as the primary reason for choosing the ED. The interviews revealed that a major obstacle to workers using alternative facilities was the lack of a government-issued health card, which is available to all citizens and residents at a nominal rate. CONCLUSION Reducing the number of low-acuity cases in the emergency department at HGH will require interventions aimed at encouraging patients with non-urgent conditions to use alternative healthcare facilities. Potential interventions include policy changes that require employers to either provide workers with a health card or compel employees to acquire one for themselves.
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de Valk J, Taal EM, Nijhoff MS, Harms MH, Lieshout EMM, Patka P, Rood PPM. Self-referred patients at the Emergency Department: patient characteristics, motivations, and willingness to make a copayment. Int J Emerg Med 2014; 7:30. [PMID: 25097671 PMCID: PMC4115339 DOI: 10.1186/s12245-014-0030-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In many countries, including the Netherlands, a substantial number of patients visit the Emergency Department (ED) without a referral by a general practitioner. The goal of this study was to determine the characteristics and motivations of self-referred patients (SRPs) at the ED. The secondary objective was to explore SRPs' opinion about copayments. METHODS A survey, in seven different languages was performed among SRPs from October 2011 until January 2012 at an academic ED in the Netherlands. Patients were included on 21 day-, 21 evening-, and 21 nightshifts during week and weekend days equally. Patient characteristics, motivations, complaints, diagnosis, and the opinion regarding copayments were examined. RESULTS A total of 436 SRPs were included (response rate 82%). Forty-seven percent of the ED population was self-referred. SRPs were mainly male (58%), between 18 and 35 years (54%), Dutch (67%), single without children (42%), and low-educated (73%). The most commonly presented complaints were of musculoskeletal origin (35%). Expected need for additional medical care (e.g., X-rays, blood tests) was the reason to visit the ED for 28% of the SRPs. Around 30% of the SRPs were not prepared to pay for an ED visit. Fifty percent of SRPs were prepared to pay up to 25 or 50 EUR. Highly educated patients were willing to pay more than patients with a low level of education (p < 0.05). CONCLUSIONS SRPs (47% of the total ED population) are often young men with musculoskeletal complaints. They are convinced that additional medical tests are necessary. About 70% of the SRPs are willing to make a copayment, half of the SRPs with a maximum between 25 EUR and 50 EUR. As highly educated SRPs are prepared to pay more, introducing copayments might influence equity in health care accessibility.
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Affiliation(s)
- Janneke de Valk
- Department of Emergency Medicine, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, 3000, CA, The Netherlands
| | - Elisabeth M Taal
- Department of Emergency Medicine, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, 3000, CA, The Netherlands
| | - Mariette S Nijhoff
- Department of Emergency Medicine, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, 3000, CA, The Netherlands
| | - Maren H Harms
- Department of Emergency Medicine, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, 3000, CA, The Netherlands
| | - Esther MM Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, 3000, CA, The Netherlands
| | - Peter Patka
- Department of Emergency Medicine, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, 3000, CA, The Netherlands
| | - Pleunie PM Rood
- Department of Emergency Medicine, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, 3000, CA, The Netherlands
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Chmiel C, Rosemann T, Senn O. Demand and characteristics of a psychiatric 24-hour emergency service performed by mandatory rotation of licensed psychiatrists in Swiss primary care. Patient Prefer Adherence 2014; 8:383-90. [PMID: 24707172 PMCID: PMC3972023 DOI: 10.2147/ppa.s53950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To investigate characteristics of and satisfaction with psychiatric 24-hour emergency primary care performed by mandatory rotation of licensed psychiatrists as a viable baseline for possible reorganizational measures. METHODS This was a questionnaire-based cross-sectional study (November 2010-April 2011). The number of patient-psychiatrist encounters, modes of contact, and patient and psychiatrist characteristics were assessed. Diagnoses were coded with ICD-10 (International Classification of Diseases, version 10). RESULTS From 167 duty episodes, 74 (44%) were recorded. Of the psychiatrists (n=44), 52% were female, and mean age (standard deviation) was 49.9 (5.2) years. The median number of encounters per episode was 4 (interquartile range 0-8), mainly in the evenings. Demand for "face-to-face" (direct) patient visits was significantly more common (64.0%) than practice (1.3%) or telephone consultations (34.7%). In 83.8%, psychiatrists judged the encounter as adequate at the patient's location. A total of 43 different diagnoses were recorded: mainly schizophrenic disorders (23.9%), suicidal behavior (15.2%), and acute stress reactions (10.3%). Psychiatrists felt burdened by services (62.5%): in 39.2%, they felt threatened; and in 6.8%, violence occurred. In 32.4%, bills were not paid for. If services were optional, 45.2% would participate. CONCLUSION Our findings indicate justified demand for direct mobile patient visits, suggesting that emergency care should be multifaceted, and sole provision of psychiatric care at stationed emergency facilities may not always be appropriate. Reorganization of 24-hour emergency services should carefully evaluate patient and provider's needs before changing established structures.
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Affiliation(s)
- Corinne Chmiel
- Institute of General Practice and Health Services Research, University of Zurich, Raemistrasse, Zurich, Switzerland
- Correspondence: Corinne Chmiel, University of Zurich, Institute of General Practice and Health Services Research, Raemistrasse 100, 8091 Zurich, Switzerland, Tel +41 44 255 8509, Fax +41 44 255 9097, Email
| | - Thomas Rosemann
- Institute of General Practice and Health Services Research, University of Zurich, Raemistrasse, Zurich, Switzerland
| | - Oliver Senn
- Institute of General Practice and Health Services Research, University of Zurich, Raemistrasse, Zurich, Switzerland
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Eichler K, Hess S, Chmiel C, Bögli K, Sidler P, Senn O, Rosemann T, Brügger U. Sustained health-economic effects after reorganisation of a Swiss hospital emergency centre: a cost comparison study. Emerg Med J 2013; 31:818-23. [PMID: 23850883 PMCID: PMC4174047 DOI: 10.1136/emermed-2013-202760] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Emergency departments (EDs) are increasingly overcrowded by walk-in patients. However, little is known about health-economic consequences resulting from long waiting times and inefficient use of specialised resources. We have evaluated a quality improvement project of a Swiss urban hospital: In 2009, a triage system and a hospital-associated primary care unit with General Practitioners (H-GP-unit) were implemented beside the conventional hospital ED. This resulted in improved medical service provision with reduced process times and more efficient diagnostic testing. We now report on health-economic effects. Methods From the hospital perspective, we performed a cost comparison study analysing treatment costs in the old emergency model (ED, only) versus treatment costs in the new emergency model (triage plus ED plus H-GP-unit) from 2007 to 2011. Hospital cost accounting data were applied. All consecutive outpatient emergency contacts were included for 1 month in each follow-up year. Results The annual number of outpatient emergency contacts increased from n=10 440 (2007; baseline) to n=16 326 (2011; after intervention), reflecting a general trend. In 2007, mean treatment costs per outpatient were €358 (95% CI 342 to 375). Until 2011, costs increased in the ED (€423 (396 to 454)), but considerably decreased in the H-GP-unit (€235 (221 to 250)). Compared with 2007, the annual local budget spent for treatment of 16 326 patients in 2011 showed cost reductions of €417 600 (27 200 to 493 600) after adjustment for increasing patient numbers. Conclusions From the health-economic point of view, our new service model shows ‘dominance’ over the old model: While quality of service provision improved (reduced waiting times; more efficient resource use in the H-GP-unit), treatment costs sustainably decreased against the secular trend of increase.
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Affiliation(s)
- Klaus Eichler
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Sascha Hess
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Corinne Chmiel
- City Hospital Waid, Zurich, Switzerland Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland
| | | | | | - Oliver Senn
- Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland
| | - Urs Brügger
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
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Huibers L, Thijssen W, Koetsenruijter J, Giesen P, Grol R, Wensing M. GP cooperative and emergency department: an exploration of patient flows. J Eval Clin Pract 2013; 19:243-9. [PMID: 22304568 DOI: 10.1111/j.1365-2753.2011.01806.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES In most countries, different health care providers are involved in emergency care. In the Netherlands, out-of-hours care is provided by general practitioner cooperatives (GPCs) and emergency departments (EDs). Our aim was to describe the flow of patients attending emergency care in these settings. METHOD A retrospective record review was performed, concerning patients who had visited a GPC or ED. Recorded information included urgency, diagnostic tests, and follow-up contacts. Descriptive figures were determined for patient flows in GPC and ED for urgent contacts and non-urgent contacts. RESULTS We included 319 GPC contacts and 356 ED contacts, of which 78% were non-urgent. The majority of GPC contacts were completed at the GPC without follow-up; 37% of non-urgent patients had a follow-up contact, usually with primary care. Only 5% of non-urgent GPC patients received diagnostic tests compared to 63% of non-urgent ED patients (mostly X-rays). The majority of non-urgent ED patients (88%) had a follow-up contact, usually at an outpatient clinic (67%). Most non-urgent ED patients (83%) who received a diagnostic test also had an outpatient clinic follow-up contact. Of urgent ED patients, the majority had a follow-up contact (85%), mostly with an outpatient clinic (74%). CONCLUSION Although most out-of-hours care patients present non-urgent health problems, at the ED they are more likely to receive diagnostic tests and follow-up contacts. This may reflect differences in patient populations between the ED and GPC or suggest opportunities for improving efficiency of planning follow-up contacts.
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Affiliation(s)
- Linda Huibers
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Benahmed N, Laokri S, Zhang WH, Verhaeghe N, Trybou J, Cohen L, De Wever A, Alexander S. Determinants of nonurgent use of the emergency department for pediatric patients in 12 hospitals in Belgium. Eur J Pediatr 2012; 171:1829-37. [PMID: 23064744 DOI: 10.1007/s00431-012-1853-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 10/01/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The nonurgent use of the emergency department (ED) for pediatric patients is an increasing problem facing healthcare systems worldwide. To evaluate the magnitude of the phenomenon and to identify associated factors, an observational prospective survey was performed including all patients (<15 years) attending the ED in 12 Belgian hospitals during 2 weeks in autumn 2010. Use of ED was considered appropriate if at least one of the following criteria was met: child referred by doctor or police, brought by ambulance, in need for short stay, technical examination or orthopedic treatment, in-patient admission, or death. Among the 3,117 children, attending ED, 39.9 % (1,244) of visits were considered inappropriate. Five factors were significantly associated with inappropriate use: age of child, distance to ED, having a registered family doctor, out-of-hours visit, and geographic region. The adjusted odds ratio and 95 % confidence intervals are respectively-1.7 (1.3-2.0), 1.7 (1.3-2.2), 1.5 (1.1-2.2), 1.5 (1.2-1.9), and 0.6 (0.5-0.8). CONCLUSIONS Almost 40 % of all paediatric ED attendances did not require hospital expertise. The risk of an inappropriate use of ED by pediatrician patients is predominantly associated with organizational and cultural factors. Access, equity, quality of care, and medical human resources availability have to be taken into account to design financially sustainable model of care for those patients. Furthermore, future research is needed to explain reasons why parents visit ED rather than using of primary-care services.
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Affiliation(s)
- N Benahmed
- CREGISI (Research Center for Health Economics, Health Facilities Management and Nursing Sciences), School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.
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Malmström T, Huuskonen O, Torkki P, Malmström R. Structured classification for ED presenting complaints - from free text field-based approach to ICPC-2 ED application. Scand J Trauma Resusc Emerg Med 2012; 20:76. [PMID: 23176447 PMCID: PMC3564900 DOI: 10.1186/1757-7241-20-76] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 11/22/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there is a major need to record and analyse presenting complaints in emergency departments (EDs), no international standard exists. The aim of the present study was to produce structured complaint classification suitable for ED use and to implement it in practice. The structured classification evolved from a study of free text fields and ICPC-2 classification. METHODS Presenting complaints in a free text field of ED admissions during a one-year period (n=40610) were analyzed and summarized to 70 presenting complaint groups. The results were compared to ICPC-2 based complaints collected in another ED. An expert panel reviewed the results and produced an ED application of ICPC-2 classification. This study implemented the new classification into an ED. RESULTS The presenting complaints summarized from free text fields and those from ICPC-2 categories were remarkably similar. However, the ICPC-2 classification was too broad for ED; an adapted version was needed. The newly developed classification includes 89 presenting complaints and ED staff found it easy to use. CONCLUSIONS ICPC-2 classification can be adapted for ED use. The authors suggest a list of 89 presenting complaints for use in EDs adult patients.
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Affiliation(s)
- Tomi Malmström
- Institute of Healthcare Engineering and Management, Department of Industrial Engineering and Management, Aalto University, Otaniementie 17, 00076, Aalto, Finland
| | - Olli Huuskonen
- Jorvi Hospital, Division of Emergency Care, Meilahti Hospital, Helsinki University Hospital District, Helsinki, Finland
| | - Paulus Torkki
- Institute of Healthcare Engineering and Management, Department of Industrial Engineering and Management, Aalto University, Otaniementie 17, 00076, Aalto, Finland
| | - Raija Malmström
- Department of Medicine, Division of Emergency Care, Meilahti Hospital, Helsinki University Hospital District, Helsinki, Finland
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Hou XY, Zhao J, Chu K. Impact of a government triple zero awareness campaign on emergency department patient characteristics. Emerg Med Australas 2012; 24:393-400. [PMID: 22862756 DOI: 10.1111/j.1742-6723.2012.01560.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the impact of a government triple zero community awareness campaign on the characteristics of patients attending an ED. METHODS A study using Emergency Department Information System data was conducted in an adult metropolitan tertiary-referral teaching hospital in Brisbane. The three outcomes measured in the 3 month post-campaign period were arrival mode, Australasian Triage Scale and departure status. These measures reflect ambulance usage, clinical urgency and illness severity, respectively. They were compared with those in the 3 month pre-campaign period. Multivariate logistic regression models were used to investigate the impacts of the campaign on each of the three outcome measures after controlling for age, sex, day and time of arrival, and daily minimum temperature. RESULTS There were 17,920 visits in the pre- and 17,793 visits in the post-campaign period. After the campaign, fewer patients arrived at the ED by road ambulance (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.80-1.00), although the impact of the campaign on the arrival mode was only close to statistical significance (Wald χ(2) -test, P= 0.055); and patients were significantly less likely to have higher clinical urgency (OR 0.86, 95% CI 0.79-0.94), while more likely to be admitted (OR 1.68, 95% CI 1.38-2.05) or complete treatment in the ED (OR 1.46, 95% CI 1.23-1.73) instead of leaving without waiting to be seen. CONCLUSIONS The campaign had no significant impact on the arrival mode of the patients. After the campaign, the illness acuity of the patients decreased, whereas the illness severity of the patients increased.
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Affiliation(s)
- Xiang-Yu Hou
- Institute of Health and Biomedical Innovation, School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059, Australia.
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