Effect of Access to After-Hours Primary Care on the Association Between Home Nursing Visits and Same-Day Emergency Department Use

Association Between Primary Care Availability and Emergency Medical Services Utilization

BACKGROUND

Emergency medical services (EMS) contribute to the vital role of providing health care to an individual by delivering time-sensitive, episodic treatment to patients with acute illnesses. Understanding which factors impact EMS utilization can help guide policies and allocate resources more effectively. Increasing primary care access has often been touted to decrease unnecessary emergency care utilization.

OBJECTIVES

This study seeks to determine whether a relationship exists between access to primary care and EMS utilization.

METHODS

Using data from the National Emergency Medical Services Information System, Area Health Resources Files, and County Health Rankings and Roadmaps, U.S. county-level data were analyzed to determine whether increased access to primary care (and insurance coverage) was associated with decreased EMS utilization.

RESULTS

Higher primary care availability is associated with less EMS utilization only when insurance coverage in the community surpassed 90%.

CONCLUSIONS

Insurance coverage can play an important role in decreasing EMS utilization and may also impact the effect of increased primary care physician availability on EMS utilization in a region.

Home Care Nursing Visits and Same-Day Emergency Department Use: Which Patients Are Most at Risk?

BACKGROUND

Home care patients are a growing group of community-dwelling older adults with complex care needs and high health service use. Adult home care patients are at high risk for emergency department (ED) visits, which is greater on the same day as a nursing visit.

PURPOSE

The purpose of this study was to examine whether common nursing indicators modified the association between nursing visits and same-day ED visits.

METHODS

A case-crossover design within a retrospective cohort of adult home care patients in Ontario.

RESULTS

A total of 11,840 home care nursing patients were analyzed. Home care patients who received a home nursing visit were more likely to go the ED afterhours on the same day with a stronger association for visits not admitted to the hospital. Having a urinary catheter increased the risk of a same-day ED visit (OR: 1.78 (95% CI 1.15-1.60) vs. 1.21 (95% CI 1.15-1.28)). No other clinical indicator modified the association.

CONCLUSIONS

The findings of this study can be used to inform care policies and practices for home care nurses in the management of indwelling urinary catheter complications. Further examination of system factors such as capacity and resources available to respond to catheter related complications in the community setting are recommended.