Connecting Emergency Department Patients to Primary Care

Wexler, Randy; Hefner, Jennifer L; Sieck, Cynthia J.; Taylor, Christopher A.; Lehman, Jennifer; Panchal, Ashish R.; Aldrich, Alison; McAlearney, Ann Scheck

doi:10.3122/jabfm.2015.06.150044

Cited by 14 publications

(10 citation statements)

References 22 publications

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“…Accessing well-established PHC reduces ED’s visits by approximately 50% and referrals to specialty care by 30% [22]. Lack of regular access to PCPs is one of the reasons for ED overcrowding worldwide [23, 24]. An international study conducted by van den Berg et al to investigate how the likelihood of attending an ED is related to accessibility of primary care showed the percentages of participants not having PCP in the following countries: 7.8% in Denmark, 10.7% in Belgium, 16.6% in Finland, 20.5% in England, 23.8% in Australia, 25.7% in Canada, 29% in Germany, 41% in Norway and Slovenia, 51.9% in Czech Republic, and 73.6% in Slovakia [25].…”

Section: Discussionmentioning

confidence: 99%

Exploring emergency department visits: factors influencing individuals’ decisions, knowledge of triage systems and waiting times, and experiences during visits to a tertiary hospital in Saudi Arabia

et al. 2019

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BackgroundIn recent years, there has been an increased utilization of emergency departments (EDs) in many countries. Additionally, it is reported that there are major delays in delivering care to ED patients. Longer waiting times are associated with poor patient satisfaction, whereas an understanding of the triage process increases satisfaction. This study aimed to assess ED visitor’s awareness of the triage procedure and their preferences regarding delayed communication.MethodsCross-sectional study of King Abdulaziz Medical City – Emergency Department visitors using a previously validated questionnaire (Seibert 2014) which was translated to Arabic, piloted, and then used for this study.ResultsA total of 334 questionnaires were returned. The mean age of respondents was 33 years. Regarding primary care physicians, only 16% of respondents said that they have one. About 21% of those tried to communicate with them before coming to the ED. Even though only 11% of respondents knew exactly what triage is, 51% were able to correctly explain why some patients are seen before others. Statistical analysis did not show any factors that are associated with increased knowledge of triage. Most respondents (75%) want to hear updates regarding delays with 69% of them preferring to be updated every 30 min.ConclusionsThis study showed that the majority of patients do not know what triage means and that most of them want to know how the ED works. Moreover, a lot of respondents said that they do not have a primary care physician. These results support increasing patient awareness by education and involving them if any delay happens.

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Section: Discussionmentioning

confidence: 99%

Exploring emergency department visits: factors influencing individuals’ decisions, knowledge of triage systems and waiting times, and experiences during visits to a tertiary hospital in Saudi Arabia

et al. 2019

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“…15,34 The non-significant reduction in ED use found in this study underscores the mixed evidence in the literature. At least seven prior studies 12,13,[35][36][37][38][39] showed ED use reductions following a CM or similar intervention, while five studies 9,11,14,40,41 did not. In terms of study design, sample size and intervention (i.e.…”

Section: Discussionmentioning

confidence: 99%

Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial

et al. 2016

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BACKGROUND: Frequent emergency department (ED) users account for a disproportionately high number of ED visits. Studies on case management (CM) interventions to reduce frequent ED use have shown mixed results, and few studies have been conducted within a universal health coverage system. OBJECTIVE: To determine whether a CM intervention--compared to standard emergency care-reduces ED attendance. DESIGN: Randomized controlled trial. PARTICIPANTS: Two hundred fifty frequent ED users (5 or more visits in the prior 12 months) who visited a public urban ED at the Lausanne University Hospital between May 2012 and July 2013 were allocated to either an intervention (n = 125) or control (n = 125) group, and monitored for 12 months. INTERVENTIONS: An individualized CM intervention consisting of concrete assistance in obtaining income entitlements, referral to primary or specialty medical care, access to mental health care or substance abuse treatment, and counseling on at-risk behaviors and health care utilization (in addition to standard care) at baseline and 1, 3, and 5 months. MAIN MEASURES: We used a generalized linear model for count data (negative binomial distribution) to compare the number of ED visits during the 12-month follow-up between CM and usual care, from an intention-to-treat perspective.KEY RESULTS: At 12 months, there were 2.71 (±0.23) ED visits in the intervention group versus 3.35 (±0.32) visits among controls (ratio = 0.81, 95 % CI = 0.63; 1.02). In the multivariate model, the effect of the CM intervention on the number of ED visits approached statistical significance (b = −0.219, p = 0.075). The presence of poor social determinants of health was a significant predictor of ED use in the multivariate model (b = 0.280, p = 0.048). CONCLUSIONS: CM may reduce ED use by frequent users through an improved orientation to the health care system. Poor social determinants of health significantly increase use of the ED by frequent users.

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“…10 One intervention study conducted in the United States, the objective of which was to integrate patients cared for by emergency services into PHC services, identified the main barriers preventing patients from seeking PHC care as including a lack of transportation and difficulties in leaving children under someone's else responsibility. 14 In England, fragmentation that still exists in the health system doubles the effort and difficulties patients have to face to go through the network efficiently. Additionally, the different names of services cause confusion, so patients do not have their needs met the first time because they do not go to the right place, consequently do not receive care from professionals with the right abilities in the first consultation.…”

Section: Discussionmentioning

confidence: 99%

“…The reasons for the difficulties include the PHC units' reduced working hours, which hinders the access of the working population, and the fact that UPAs have access to resources with greater technology so that patients do not have to commute to other services in the network. 14,16 Data collected from the reports provided by the Infosaúde system did not enable the researchers to assess the hours those patients classified as being intercurrences or outpatients were served. Identifying the times care was provided, whether patients visited the service at night or during weekends or holidays, would confirm whether UPAs serve as a backup for PHC services.…”

Section: Discussionmentioning

confidence: 99%

Demand and Type of Care Provided in Emergency Services in the City of Florianópolis, Brazil

Cassettari¹,

Mello

2017

Texto contexto - enferm.

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Objective: this study's aim was to characterize the demand of patients and the type of care provided in 2013, in emergency services, in the city of Florianópolis, SC, Brazil.Method: this is a descriptive and analytical study with a quantitative approach. Secondary data were collected from general and managerial reports provided by the information system used by the city's department of health.Results: patients seek the emergency services nearest to their homes for situations not characterized as emergencies and that could be taken care of by primary health care units Conclusion: most patients originate from the same health district in which the emergency service is located and their reasons for seeking care could not be characterized as urgent or emergency situations. There is a need to qualify primary health care as the coordinator of care and instruct the population regarding the role of each service in the network. DESCRIPTORS:Health services. Health services needs and demand. Prehospital care Emergency medical services. DEMANDA E TIPO DE ATENDIMENTO REALIZADO EM UNIDADES DE PRONTO ATENDIMENTO DO MUNICíPIO DE FLORIANÓPOLIS, BRASIL RESUMOObjetivo: caracterizar a demanda de usuários e o tipo de atendimento realizado em Unidades de Pronto Atendimento do município de Florianópolis, Santa Catarina, Brasil, no ano de 2013.Método: trata-se uma pesquisa descritiva e analítica com abordagem quantitativa. Foram coletados dados secundários, obtidos por meio de relatórios gerais e gerenciais do sistema de informação, utilizado pela Secretaria de Saúde da capital.Resultados: constatou-se que os usuários utilizam a Unidade de Pronto Atendimento que está mais próxima de residência e que procuram o serviço por motivos não urgentes, que poderiam ser atendidos na atenção primária.Conclusão: a maioria dos usuários era proveniente do mesmo distrito sanitário da unidade e os motivos dos atendimentos não eram, precisamente, caracterizados como urgência e emergência. Percebe-se a necessidade de qualificar a atenção primária como ordenadora do cuidado e orientar a população sobre quais as atribuições de cada ponto da rede. Método: investigación descriptiva y analítica con abordaje cuantitativo. Fueron recolectados datos secundarios, obtenidos a través de relatorías generales y gerenciales del sistema de información, utilizado por la Secretaría de Salud de la capital. DESCRITORES:Resultados: Se constató que los usuarios utilizan la Unidad de Emergencia que está más próxima de la residencia y que procuran el servicio por motivos no urgentes, que podrían ser atendidos en la atención primaria.Conclusión: la mayoría de usuarios era proveniente del mismo distrito sanitario de la unidad y los motivos de atendimientos no eran precisamente, caracterizados como de urgencia y emergencia. Se percibe la necesidad de calificar la atención primaria como ordenadora del cuidado y orientar a la población sobre cuáles son las atribuciones de cada punto de la red. DESCRIPTORES: Servicios de salud. Necesidades y demandas de servicios de salud. A...

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Connecting Emergency Department Patients to Primary Care

Cited by 14 publications

References 22 publications

Exploring emergency department visits: factors influencing individuals’ decisions, knowledge of triage systems and waiting times, and experiences during visits to a tertiary hospital in Saudi Arabia

Exploring emergency department visits: factors influencing individuals’ decisions, knowledge of triage systems and waiting times, and experiences during visits to a tertiary hospital in Saudi Arabia

Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial

Demand and Type of Care Provided in Emergency Services in the City of Florianópolis, Brazil

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