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

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.

The influence of electronic reminders on recording diagnoses in a primary health care emergency department: a register-based study in a Finnish town

“…Indeed, a change in the triage system, namely, the adoption of the so-called ‘reverse triage’, was initiated in the beginning of 2008 [ 17 ]. In this type of triage-method an ED tries to redirect patients with mild health disorders to office-hour general practitioners [ 17 ], thereby reducing the number of patients entering the primary health care ED [ 28 ]. Indirectly, this change in ICD-10 code J-group diagnoses recordings may suggest that by using ‘reverse triage’ the ED succeeded in reducing the amount of certain types of patients entering the facility, such as those with mild respiratory infections.…”

Do electronic reminders alter recorded diagnoses in primary care office-hours practices of health centers: A register-based study in a Finnish city

“…One possible explanation for these discrepancies may be that the overall number of visits to the office-hours PCPs decreased during the follow-up period in the city of Vantaa. 27 Decreasing visits to PCPs has been a consistent and general trend in Finnish primary health care, while the precise reasons for this remain unknown. 28 , 29 This decrease affected the percentage counted from all visits considerably, but not that counted from visits with recorded diagnoses.…”

Development of The Use of Primary Health Care Emergency Departments After Interventions Aimed At Decreasing Overcrowding: A Longitudinal Follow-up Study

“…This intervention has been described in detail before [4] and it led to a situation, where those patients who judged by themselves that their health issue did not require emergency actions did not arrive at the ED. In practice, these interventions led to a situation where the amount of doctor visits in the primary care ED system decreased by almost 50% [2][3][4][5].…”

“…The actions were: application of ABCDE-triage combined with public guidance on the proper use of EDs [2], closure of a minor supplementary ED [3], and, nally, application of "reverse triage" with enhanced guiding of the public to o ce-hours services and away from the remaining ED [4]. The strategy was that those patients who did not require doctor services in EDs would be guided to o ce-hours GPs in the local primary care by the primary care system itself [5]. This strategy did not work as planned: patients were not directed to o ce-hours physicians [5].…”

“…The strategy was that those patients who did not require doctor services in EDs would be guided to o ce-hours GPs in the local primary care by the primary care system itself [5]. This strategy did not work as planned: patients were not directed to o ce-hours physicians [5]. Therefore it became important to study which patient groups in the ED were most affected by these reductions.…”