A Primary Care Emergency Service Reduction Did Not Increase Office-Hour Service Use : A Longitudinal Follow-up Study

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http://hdl.handle.net/10138/306215

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Lehto , M , Mustonen , K , Kantonen , J , Raina , M , Heikkinen , A-M K & Kauppila , T 2019 , ' A Primary Care Emergency Service Reduction Did Not Increase Office-Hour Service Use : A Longitudinal Follow-up Study ' , Journal of Primary Care & Community Health , vol. 10 , 2150132719865151 . https://doi.org/10.1177/2150132719865151

Title: A Primary Care Emergency Service Reduction Did Not Increase Office-Hour Service Use : A Longitudinal Follow-up Study
Author: Lehto, Mika; Mustonen, Katri; Kantonen, Jarmo; Raina, Marko; Heikkinen, Anna-Maria K.; Kauppila, Timo
Contributor: University of Helsinki, University of Helsinki
University of Helsinki, Staff Services
University of Helsinki, Department of General Practice and Primary Health Care
Date: 2019-07
Language: eng
Number of pages: 7
Belongs to series: Journal of Primary Care & Community Health
ISSN: 2150-1319
URI: http://hdl.handle.net/10138/306215
Abstract: 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-hour primary care would guide patients to office-hour visits to general practitioners (GP). This was an observational retrospective study based on a before-and-after design carried out by gradually decreasing ED services in primary care. The interventions were (a) application of ABCDE-triage combined with public guidance on the proper use of EDs, (b) cessation of a minor supplementary ED, and finally (c) application of "reverse triage" with enhanced direction of the public to office-hour services from the remaining ED. The numbers of visits to office-hour primary care GPs in a month were recorded before applying the interventions fully (preintervention period) and in the postintervention period. The putative effect of the interventions on the development rate of mortality in different age groups was also studied as a measure of safety. The total number of monthly visits to office-hour GPs decreased slowly over the whole study period without difference in this rate between pre- and postintervention periods. The numbers of office-hour GP visits per 1000 inhabitants decreased similarly. The rate of monthly visits to office-hour GP/per GP did not change in the preintervention period but decreased in the postintervention period. There was no increase in the mortality in any of the studied age groups (0-19, 20-64, 65+ years) after application of the ED interventions. There is no guarantee that decreasing activity in a primary care ED and consecutive enhanced redirecting of patients to the office-hour primary care systems would shift patients to office-hour GPs. On the other hand, this decrease in the ED activity does not seem to increase mortality either.
Subject: community health centers
emergency department
primary care
practice management
mortality
3142 Public health care science, environmental and occupational health
3121 General medicine, internal medicine and other clinical medicine
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