Emergency Department Use and Enrollment in a Medical Home Providing After-Hours Care

Abstract

Enrollment of adult Ontarians in a primary care medical home offering after-hours care was not associated with a reduction in emergency department use. It will therefore be important to prospectively evaluate policy reforms aimed at improving access to primary care outside of conventional hours.

Effect of Access to After-Hours Primary Care on the Association Between Home Nursing Visits and Same-Day Emergency Department Use

“…20,21 Consequently, governments around the world have put policies in place to increase the availability of after-hours primary care. 22 While the effectiveness of these policies have been called into question, 5 our results contribute evidence to the argument that there is substantial benefit. Increasing the provision and use of after-hours primary care, at individual practices or system wide, through policy tools such as regulations or incentives could yield benefits for complex, community-dwelling older adults such as home care patients.…”

“…Some cross-sectional and survey studies have suggested that an increase in access to primary after-hours care could reduce emergency department visits 4,[17][18][19] while other cohort studies and systematic reviews of interventions found no reduction. 5,6 Our study is novel in that it tests the effectiveness of after-hours primary care in terms of its ability to reduce the risk of an emergency department visit following an event known to increase risk and does so within a selfmatched study design. In contrast to other studies, our study does not seek to determine whether after-hours primary care can reduce emergency department use overall, but rather if it can prevent visits that would otherwise occur shortly after a home nursing visit.…”

“…1,2 The existing literature testing this hypothesis, however, has produced conflicting results, with some studies showing that increased access to after-hours primary care is associated with fewer emergency department visits 3,4 and others finding no difference. 5,6 Older adults receiving home care services are a growing, frail population with particularly high rates of emergency department use. 7,8 Previous research has found that home nursing patients in Ontario, Canada have an increased risk of visiting the emergency department after 5:00 pm on the same day they receive a home nursing visit.…”

A multi-year retrospective quantitative implementation evaluation of Safer Opioid Prescribing, an opioid prescribing continuing education program for Canadian healthcare providers

“…The Ontario Medical Association's (OMA) Rurality Index of Ontario was used to determine a rurality score based on practice postal code. This Index has been used in other program evaluations as a measure of rurality for Ontario physicians (43). For data pertaining to the rurality of the Ontario family physician population (as a comparator to our participant group), we combined the OMA-generated RIO score at the Census Sub-Division level (44) with the Ontario Physician Human Resources Data Center's list of Physician Counts by Census Sub-Division for 2017 (45).…”

In This Issue: Nothing Simple

“…9 In a study of initial patient enrollment in a medical home mandated to provide after-hours care, Kiran et al find increases in the rate of emergency department visits and the proportion of primary care visits occurring on the weekend, and a decrease in the overall primary care visit rate. 10 Contextual factors seem important in interpreting these findings from Ontario, Canada.…”