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

Jones, Aaron; Bronskill, Susan E.; Schumacher, Connie; Seow, Hsien; Feeny, David; Costa, Andrew P.

doi:10.1370/afm.2571

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…Our finding of higher odds of more frequent ED visits among patients who called the HC for urgent care or afterhours likely indicate urgency of need for advice or care. 10,38,39 Due to the crosssectional nature of our data, it is not clear if the ED visits occurred before the calls or after. In the former case, frequent ED visits may indicate lack of timely access to care.…”

Section: Discussionmentioning

confidence: 98%

“…In the latter case, patients’ calls may indicate seeking primary care to address the health issues that led to the ED visits 7,40 . Past literature about access to after‐hours or urgent care has been inconsistent, with some studies suggesting such access could reduce ED visits while others finding no difference 10,39,41 . For HCs, these findings likely indicate the need for increased capacity for afterhours care and same‐day appointments.…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with frequent emergency department visits among health centre patients receiving primary care

Pourat¹,

Lu²,

Chen³

et al. 2023

Evaluation Clinical Practice

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Rationale, Aims and ObjectivesWe sought to examine specific care‐seeking behaviours and experiences, access indicators, and patient care management approaches associated with frequency of emergency department (ED) visits among patients of Health Resources and Services Administration‐funded health centres that provide comprehensive primary care to low‐income and uninsured patients.MethodWe used cross‐sectional data of a most recent nationally representative sample of health centre adult patients aged 18–64 (n = 4577) conducted between October 2014 and April 2015. These data were merged with the 2014 Uniform Data System to incorporate health centre characteristics. We measured care‐seeking behaviours by whether the patient called the health centre afterhours, for an urgent appointment, or talked to a provider about a concern. Access to care indicators included health centre continuity of care and receipt of transportation or translation services. We included receipt of care coordination and specialist referral as care management indicators. We used a multilevel multinomial logistic regression model to identify the association of independent variables with number of ED visits (4 or more visits, 2–3 visits, 1 visit, vs. 0 visits), controlling for predisposing, enabling, and need characteristics.ResultsCalling the health centre after‐hours (OR = 2.41) or for urgent care (OR = 2.53), and being referred to specialists (OR = 2.36) were associated with higher odds of four or more ED visits versus none. Three or more years of continuity with the health centre (OR = 0.32) was also associated with lower odds of four or more ED visits versus none.ConclusionsFindings underscore opportunities to reduce higher frequency of ED visits in health centres, which are primary care providers to many low‐income populations. Our findings highlight the potential importance of improving patient retention, better access to providers afterhours or for urgent visits, and access to specialist as areas of care in need of improvement.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Factors associated with frequent emergency department visits among health centre patients receiving primary care

Pourat¹,

Lu²,

Chen³

et al. 2023

Evaluation Clinical Practice

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show abstract

“…Hypothesizing that these increased ED visits could be reduced when long-term care home residents have access to after-hour primary care, researchers conducted a case-crossover study of residents of Ontario long-term care homes and concluded that increasing afterhours access to primary care could reduce some low acuity visits in this population. 119…”

Section: Limited Inpatient Workforcementioning

confidence: 99%

Interventions Intended to Alleviate Emergency Department Overcrowding

Mason,

Secord,

MacDougall

2023

cjht

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Why Is This an Issue? Emergency department (ED) overcrowding is a known issue in Canada that puts patients’ lives and health at risk when treatment needs within the ED exceed the resources required to address them. The causes and consequences of ED overcrowding are complex, varied, and extend beyond the ED. Left unchecked, ED overcrowding contributes to a deteriorating standard of care as staff become overworked and burned out. What Are the Potential Interventions to Address ED Overcrowding? This roundup of 87 new and emerging interventions intended to alleviated ED overcrowding complements CADTH’s Emergency Department Overcrowding: An Environmental Scan of Contributing Factors and a Summary of Systematic Review Evidence on Interventions. Interventions were included in this report if they are not captured in CADTH’s complimentary report Emergency Department Overcrowding: An Environmental Scan of Contributing Factors and a Summary of Systematic Review Evidence on Interventions because they are either new or are not yet in wide use in EDs and health systems across Canada and could be reasonably be expected to affect ED overcrowding (e.g., by improving patient flow through the ED or reducing the number of people seeking care in the ED). Interventions that could address multiple causal factors (e.g., e-consult services) were also included. What Is the Potential Impact? Decreasing ED overcrowding has the potential to improve the standard of care delivered to those accessing EDs and contribute to decreasing the burden on ED staff, regardless of the intervention or which contributing factor it aims to act upon. Some interventions that can alleviate ED overcrowding also have an impact on primary and community care; bolstering preventive care, increasing access to diagnostic testing for those who need it, and improving access to health care supports can improve health outcomes. What Else Do We Need to Know? The pan-Canadian issue of ED overcrowding calls for real solutions. CADTH is examining the evidence and expert-informed considerations and producing a series of publications about the causes and consequences of, and solutions to, ED overcrowding in health care systems across the country. The interventions identified in this report may be of interest to senior health care decision-makers who are anticipating health system innovation and transformation.

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“…Given these knowledge gaps, the objective of this study was to measure the association between the use of virtual end-of-life care and acute healthcare use (emergency department, hospitalization) and an out-of-hospital death before and after the introduction of specialized fee codes that enabled broader delivery of virtual care during the COVID-19 pandemic. We hypothesized that virtual end-of-life care would be associated with lower rates of acute healthcare use and an increased likelihood of an out-of-hospital death, given that people receiving end-of-life care would have increased access to their physician via virtual care, wanted to avoid unnecessary exposure to SARS-CoV-2 during the pandemic, and generally prefer to die at home [10,[17][18][19]. This study asks a novel research question that helps describe the impact of the COVID-19 pandemic on people at the end-of-life and may prompt further discussion on use-cases for virtual care.…”

Section: Introductionmentioning

confidence: 99%

Association of virtual end-of-life care with healthcare outcomes before and during the COVID-19 pandemic: A population-based study

Lapp,

Stukel,

Chung

et al. 2024

PLOS Digit Health

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The use of virtual care for people at the end-of-life significantly increased during the COVID-19 pandemic, but its association with acute healthcare use and location of death is unknown. The objective of this study was to measure the association between the use of virtual end-of-life care with acute healthcare use and an out-of-hospital death before vs. after the introduction of specialized fee codes that enabled broader delivery of virtual care during the COVID-19 pandemic. This was a population-based cohort study of 323,995 adults in their last 90 days of life between January 25, 2018 and December 31, 2021 using health administrative data in Ontario, Canada. Primary outcomes were acute healthcare use (emergency department, hospitalization) and location of death (in or out-of-hospital). Prior to March 14, 2020, 13,974 (8%) people received at least 1 virtual end-of-life care visit, which was associated with a 16% higher rate of emergency department use (adjusted Rate Ratio [aRR] 1.16, 95%CI 1.12 to 1.20), a 17% higher rate of hospitalization (aRR 1.17, 95%CI 1.15 to 1.20), and a 34% higher risk of an out-of-hospital death (aRR 1.34, 95%CI 1.31 to 1.37) compared to people who did not receive virtual end-of-life care. After March 14, 2020, 104,165 (71%) people received at least 1 virtual end-of-life care visit, which was associated with a 58% higher rate of an emergency department visit (aRR 1.58, 95%CI 1.54 to 1.62), a 45% higher rate of hospitalization (aRR 1.45, 95%CI 1.42 to 1.47), and a 65% higher risk of an out-of-hospital death (aRR 1.65, 95%CI 1.61 to 1.69) compared to people who did not receive virtual end-of-life care. The use of virtual end-of-life care was associated with higher acute healthcare use in the last 90 days of life and a higher likelihood of dying out-of-hospital, and these rates increased during the pandemic.

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

Cited by 6 publications

References 18 publications

Factors associated with frequent emergency department visits among health centre patients receiving primary care

Factors associated with frequent emergency department visits among health centre patients receiving primary care

Interventions Intended to Alleviate Emergency Department Overcrowding

Association of virtual end-of-life care with healthcare outcomes before and during the COVID-19 pandemic: A population-based study

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