Dealing with minor illnesses: The link between primary care characteristics and Walk-in Centres’ attendances

Reorganizing territorial healthcare to avoid inappropriate ED visits: does the spread of Community Health Centres make Walk-in-Clinics redundant?

“…Our empirical research consists of two steps. Pursuing Aim 1, we found confirmation of previous results [ 7 ] that patients living in an area with a local WiC show an estimated reduction of between 64 and 72% in the probability of inappropriate ED attendance. At the same time, our analysis highlights that both WiCs and CHCs can reduce patient inappropriate emergency care access probability, since for patients whose GP belongs to the local CHC, the magnitude of the reduction in inappropriate ED use is estimated at about 33% (27% in the first year), with an impact apparently greater in influencing the decision to avoid inappropriate ED use completely, but less effective when it comes to modifying the behaviour of the so-called frequent flyers.…”

“…In a previous work referring to the period 2007-2010 [7] evidence was found that by extending the opening hours of GP practices it was already possible to lower WiC attendances, casting doubts on the expediency of letting both policies -WiC and longer GP opening hours-continue to coexist in the same context and with partially overlapping objectives. With the rapid development of the CHC-model designed for globally improving both scope and availability of primary care, these doubts return to the fore with the need to assess whether CHCs act as an alternative to WiCs in providing a primary-care-based emergency service.…”

“…As the development of the CHC model is an onerous process, in both organisational and financial terms, if we found evidence of the CHC's ability to increase ED appropriateness, the NHS (National Health Service) would be forced to reconsider the advisability of leaving other existing organizational solutions unchanged in order to reduce duplication. To this end, in the second part of the paper we focus our attention on Walk-in-Clinics, fast track systems for minor injuries or illnesses in which community care is involved to contain the rising number of ED attenders presenting non-urgent health complaints [7,8,12,21,22]. Investigating the long-established WiC in the city of Parma that currently coexists with three CHCs recently established in the same catchment area, we try to assess whether, and to what extent, the progressive development of the CHCs in the city of Parma has been affecting the dynamics of WiC access.…”

“…In recent decades there has been increasing interest in improving primary care organization with specific emphasis, among other objectives, on reducing the number of ED referrals for avoidable non-severe conditions [ 1 – 3 ]. Aimed at reducing ED overuse –leading to needless expense, crowding and lower access to those in real need– wide-ranging organizational changes have been implemented in Italy mostly involving primary care, including initiatives designed to promote the extension of opening hours and out-of-hours care by GP groups [ 4 – 6 ], establish Walk-in-Clinics that are primary-care-based emergency services inside or near to hospitals [ 7 , 8 ] or, more recently to a greater extent, establish Community Health Centres (CHCs, Case della Salute in Italian) able to provide a wider range of acute and chronic medical care and, by strengthening regional healthcare, useful in increasing the appropriateness of ED visits [ 9 – 11 ].…”

Epidemiology of non‐deferrable medical conditions in primary care in Italy

“…In line with this, in the United Kingdom, GP‐led walk‐in urgent care centres, some collocated with an ED, have been established in 2009 to prevent inappropriate and inefficient attendance at the ED (Amiel et al, ). In Italy, these changes included extending opening hours and out‐of‐hours care by general practice groups and introducing walk‐in services within hospitals to make access easier for patients and establishing primary care services in order to provide more comprehensive medical care (Ugolini, Lippi Bruni, Mammi, Donatini, & Fiorentini, ).…”