The impact of walk-in centres and GP co-operatives on emergency department presentations: A systematic review of the literature

Crawford, Jessica; Cooper, Simon; Cant, Robyn; DeSouza, Ruth

doi:10.1016/j.ienj.2017.04.002

Cited by 26 publications

(30 citation statements)

References 28 publications

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“…ED utilization is an important indicator of health outcomes and access to quality primary care [Crawford, Cooper, Cant, & DeSouza, ; Fishman, McLafferty, & Galanter, ]. Existing literature suggests that adolescents with ASD [Benevides et al, ; Schlenz et al, ] or ID [McDermott et al, ] are significantly more likely to utilize the ED than the general population.…”

Section: Discussionmentioning

confidence: 99%

Emergency department utilization and monetary charges in adolescents with autism spectrum disorder, intellectual disability, and a population comparison group

et al. 2019

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Adolescents with autism spectrum disorder (ASD) and/or intellectual disability (ID) may utilize the emergency department (ED) more frequently than individuals in the general population. This study compared ED utilization and charges during adolescence among four groups of individuals: ASD‐only, ASD + ID, ID‐only, and a population comparison (PC) group. ED visits occurring during age 12–17 years were examined to identify non, low, and high utilizers. Logistic regression was used to compare groups on the odds of having at least one ED visit during adolescence. Generalized linear models were used to compare groups on number of ED visits and total charges, stratified by low and high ED utilization. Descriptive examination of presenting diagnoses was performed. Individuals with ID, with or without co‐occurring ASD, were significantly more likely to have at least one ED visit during adolescence. Among high ED utilizers, the ID‐only group had the most frequent ED visits but had significantly lower charges than the ASD‐only group. Individuals with ASD‐only and ASD + ID differed from the ID‐only and PC groups in presenting diagnoses. No differences between groups in number of ED visits or charges were observed among low utilizers. ID, with or without ASD, increased the odds of visiting the ED during adolescence. Adolescents with ID‐only had the most frequent ED visits, but individuals with ASD‐only had the highest ED charges and tended to be seen for psychiatric concerns. Further research is warranted to better characterize and meet the healthcare needs of individuals with ASD and/or ID during adolescence. Autism Res 2019, 12: 1129–1138. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary Frequent emergency department (ED) visits strain medical resources and are costlier than primary and urgent care. Our findings show that adolescents with intellectual disability (ID) may use the ED frequently for nonurgent conditions. Adolescents with autism spectrum disorder, without ID, use the ED less frequently but incur higher charges. Further research is needed to understand how to meet the unique needs of these populations in primary care to prevent overuse of the ED.

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Section: Discussionmentioning

confidence: 99%

Emergency department utilization and monetary charges in adolescents with autism spectrum disorder, intellectual disability, and a population comparison group

et al. 2019

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“…In 2017, Crawford and colleagues [ 15 ] published a systematic review and discussed the increase in non-urgent presentations (input factor) and the growing demand placed on EDs, worldwide, by potentially avoidable presentations. Much debate exists over whether these presentations add a significant burden to the workload and resource demands of crowded EDs, with some arguing they do not add a significant burden [ 16 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, there are a small number of privately run GP services that provide after-hours services. Research from the UK demonstrated that commencement of a co-located after-hours clinic reduced ED presentations [ 10 ], yet a systematic review by Crawford and colleagues concluded that evidence on the effect of GP walk-in centres was infrequent and further research is required to determine the proficiency of services as alternatives to EDs [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Investigating the referral of patients with non-urgent conditions to a regional Australian emergency department: a study protocol

Unwin

Crisp

Rigby

et al. 2018

BMC Health Serv Res

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BackgroundAustralia’s only island state, Tasmania, experiences one of the nation’s highest incidences of non-urgent emergency department (ED) presentations in a healthcare system regularly faced with service demands that exceed resource availability. Service-demand mismatches are acknowledged to contribute to ED crowding which in turn, has been documented to have a correlation with poorer patient outcomes. Crowding within EDs is complex, non-urgent presentations alone are not the primary cause, but have been reported to be a contributing factor. In 2015–16 Tasmania recorded over 153,000 ED attendances, 55% of these fell into the two least urgent triage categories. Recent research in the State’s North established that 29% of non-urgent presentations were referred, formally or informally, from primary healthcare providers and that, for many patients (39%), the ED was not their first choice of service provider. This study aims to identify the service needs of patients referred to a regional Australian ED and subsequently triaged as non-urgent.MethodIn order to achieve this aim, three objectives have been identified. The first two objectives use an explanatory sequential mixed-method approach while the third objective will incorporate an implementation science approach. These three objectives are: first, a retrospective analysis of seven years of routinely collected hospital data to identify trends in referral of patients with non-urgent conditions; second, focus group interviews with patients and primary care providers to further understand perceived need and service requirements of those referred to the ED, and third, translation of findings into local health service recommendations.DiscussionIdentification of the needs of patients referred to the ED with non-urgent conditions will inform future service planning aiming to facilitate access to the right service at the right time and in the right place.

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“…Without intermediate solutions such as WIDENESS, both traditional scheduled dental care and dental emergency services are working in suboptimal ways. For example, it has been shown that medical walk-in clinics may have the potential to reduce non-urgent emergency presentations [25].…”

Section: Interpretation and Implicationsmentioning

confidence: 99%

Improving Person-Centered Access to Dental Care: The Walk-In Dental Encounters in Non-Emergency Situations (WIDENESS)

Gulion

Vergnes

2019

Dentistry Journal

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Background: We hypothesized that access to dental care could be improved by the conceptualization of a new type of consultation: The walk-in dental encounter for non-emergency situations (WIDENESS). The aim of this study was to assess patient perspectives regarding walk-in dental consultations, with a particular focus on non-emergency situations. Methods: We followed a qualitative research approach using a semi-structured interview guide in a sample of random participants recruited from the dental department of the Toulouse University Hospital, France. We performed a thematic analysis of the interview transcripts. Data saturation was obtained after interviewing 11 participants. Results: When asked about walk-in dental consultations, three main topics emerged: (1) Walk-in dental consultation in general is important for emergency situations, but WIDENESS did not correspond to any specific long-standing need from participants;(2) WIDENESS could be a way to improve access to oral care (facilitating access to care relative to time constraints, reduction of dentist-related anxiety, better overall follow-up for the care pathway, and the complementary nature of consultations with and without appointments); and (3) WIDENESS has some potential drawbacks-apprehension about long waiting times was mentioned by several participants. Conclusions: Participants found the idea of WIDENESS promising, despite spontaneously mentioned reservations, which constitute major challenges to its implementation.

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The impact of walk-in centres and GP co-operatives on emergency department presentations: A systematic review of the literature

Cited by 26 publications

References 28 publications

Emergency department utilization and monetary charges in adolescents with autism spectrum disorder, intellectual disability, and a population comparison group

Emergency department utilization and monetary charges in adolescents with autism spectrum disorder, intellectual disability, and a population comparison group

Investigating the referral of patients with non-urgent conditions to a regional Australian emergency department: a study protocol

Improving Person-Centered Access to Dental Care: The Walk-In Dental Encounters in Non-Emergency Situations (WIDENESS)

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