Differences between recorded diagnoses of patients of an emergency department and office-hours primary care doctors: a register-based study in a Finnish town

Lehto, Mika; Mustonen, Katri; Raina, Marko; Kauppila, Timo

doi:10.1080/22423982.2021.1935593

Cited by 4 publications

(5 citation statements)

References 24 publications

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“…The study cohort is a representative sample of patients with T2D aged 60 years or older because of the integrity of the electronic patient record system in a single city, a publicly funded health care system, and inclusion of only older patients. During the follow-up, the proportion of GP appointments with a documented diagnosis in the collected dataset was at a good level (approximately 90%), as shown in a previous study using the same dataset where PHC visits and documented diagnosis were examined [ 23 ]. Inclusion of all GP and nurse appointments and not focusing on only T2D related appointments gives a more complete view of the utilization of PHC services.…”

Section: Discussionmentioning

confidence: 61%

Use of primary health care services and mortality in older patients with type 2 diabetes with or without comorbidities

Mellanen,

Kauppila,

Kautiainen

et al. 2023

Scandinavian Journal of Primary Health Care

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Objective This study aimed to examine primary health care (PHC) service utilization and mortality in older patients with type 2 diabetes (T2D) with or without comorbidities. Design and setting A cohort study in PHC in the city of Vantaa, Finland. Follow-up period was set between the years 2011 and 2018. Subjects PHC patients aged 60 years or more with a T2D were included. Main outcome measures Service utilization was defined as the number of face-to-face appointments and telephone contacts between a patient and general practitioner (GP) or nurse. The presence of comorbidities was defined using the Charlson Comorbidity Index (CCI). Mortality was assessed using hazard ratio (HR) and standardized mortality ratio (SMR). Results In total, 11,020 patients were included and followed for 71,596 person years. Mean age of the women and men in the beginning of follow-up were 71 and 69 years, respectively. The patients in the study cohort had a mean of eight appointments per person year to the GPs or nurses. Patients with T2D with comorbidities had more appointments than patients with T2D without comorbidities (incidence rate ratio (IRR) 1.44 [95% CI 1.39–1.49]). Increase in the number of all appointments reduced mortality in patients with T2D with and without comorbidities. Between patients with T2D with comorbidities and patients with T2D without comorbidities, the age and sex adjusted HR for death was 1.50 (95% CI 1.39–1.62). The SMR was higher in patients with T2D with comorbidities (1.83 [95% CI 1.74–1.92]) than in patients with T2D without comorbidities (0.91 [95% CI 0.86–0.96]). Conclusions In older patients with T2D, the presence of comorbidities was associated with increased use of PHC services and increased mortality. Increase in the number of appointments was associated with reduced mortality in patients with T2D with or without comorbidities. Key Points In older patients with T2D, it has not been studied whether and to what extend multimorbidity affects use of PHC services and mortality. The presence of comorbidities according to the Charlson Comorbidity Index (CCI) was associated with increased use of PHC services. The number of appointments to GPs or nurses was associated with reduced mortality in patients with T2D with or without comorbidities according to the CCI.

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Section: Discussionmentioning

confidence: 61%

Use of primary health care services and mortality in older patients with type 2 diabetes with or without comorbidities

Mellanen,

Kauppila,

Kautiainen

et al. 2023

Scandinavian Journal of Primary Health Care

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“…The 26 individuals who were evaluated as genuine emergencies were also excluded from the study, as mentioned in the literature. [ 14 ] Consequently, 325 patients were included in this study (Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…[ 13 ] In Finland, a study on improving the recording of diagnoses in ES was designed equally well in the emergency department and office hours practices. [ 14 ] Studies have been conducted to determine the reasons for nonurgency visits of patients and have found that it is multidimensional. [ 2 , 15 , 16 ] This study aimed to investigate why patients chose to self-refer to the emergency department instead of their primary care health center for nonurgent complaints.…”

Section: Introductionmentioning

confidence: 99%

Why patients self-refer to the emergency service for nonurgency?: A mix-method survey from a family medicine perspective

Tuz,

Özçakir

2024

Medicine

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The definition of “nonurgent emergency service visits” is visits to conditions for medical conditions that require attention but are not life-threatening immediately or severe enough to require urgent intervention. This study aims to investigate the reasons why patients choose to self-refer to the emergency service (ES) instead of their primary care health center for nonurgent complaints. The study was carried out in a tertiary hospital. The survey consisted of 2 parts with sociodemographic questions, knowledge of their family physician, and the reason why it has been applied to the ES with multiple choice answers. Of the 325 patients, the mean age was 34.5 years and 54.2% were women. Also, 26 of the patients were reported as “urgent” by the doctor. The main reasons underlying self-referred patients were classified into 4 themes: “urgency” (13.8%), advantages of ES (12.9%); disadvantages of primary care (25.1%), and other (45.9%). The most common reason patients self-refer to the ES was their belief in “being urgent” (61%). In this study, 26.8%, (n = 84) of the patients are not happy with their family physicians, while only 13.2% (N = 43) prioritize the ES advantages.

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“…The finding that the proportions and numbers of simple infections in the ED decreased is in line with the aims of the interventions applied [ 2 – 4 ]. We knew that at least about 30% of the diagnoses done in the present kind of primary care ED system and office-hours primary care were the same and that office-hours primary care might therefore have provided better continuation of treatment for these patients than the ED [ 21 ]. Furthermore, when diagnoses in EDs and primary care doctor driven emergency systems have been compared, a higher prevalence of mild infections in primary care doctor driven emergency systems and a higher prevalence of injuries in EDs have been reported [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Development of the use of primary health care emergency departments after interventions aimed at decreasing overcrowding: a longitudinal follow-up study

et al. 2022

Self Cite

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Background 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-hours primary care would modify service usage for specific gender, age or diagnosis groups. Methods This was an observational retrospective study carried out by gradually decreasing ED services in primary care. The interventions aimed at decreasing use of EDs were a) application of ABCDE-triage combined with public guidance on the proper use of EDs, b) closure of a minor supplementary ED, and finally, c) application of “reverse triage” with enhanced direction of the public to office-hours services and away from the remaining ED The annual number of visits to office-hours primary care GPs in different gender, age and diagnosis groups (International Classification of Diseases (ICD − 10) were recorded during a 13-year follow-up period. Results The total number of monthly visits to EDs decreased slowly over the whole study period. This decrease was similar in women and men. The decrease was stronger in the youngest age groups (0–19 years). GPs treated decreasing proportions of ICD-10 groups. Recorded infectious diseases (Groups A and J, and especially diagnoses related to infections of respiratory airways) tended to decrease. However, visits due to injuries and symptomatic diagnoses increased. Conclusion Decreasing services in a primary health care ED with the described interventions seemed to reduce the use of services by young people. The three interventions mentioned above had the effect of making the primary care ED under study appear to function more like a standard ED driven by specialized health care.

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Differences between recorded diagnoses of patients of an emergency department and office-hours primary care doctors: a register-based study in a Finnish town

Cited by 4 publications

References 24 publications

Use of primary health care services and mortality in older patients with type 2 diabetes with or without comorbidities

Use of primary health care services and mortality in older patients with type 2 diabetes with or without comorbidities

Why patients self-refer to the emergency service for nonurgency?: A mix-method survey from a family medicine perspective

Development of the use of primary health care emergency departments after interventions aimed at decreasing overcrowding: a longitudinal follow-up study

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