The impact of primary health care reform on hospital emergency department overcrowding: Evidence from the Portuguese reform

Almeida, Álvaro; Vales, Joana

doi:10.1002/hpm.2939

Cited by 12 publications

(8 citation statements)

References 32 publications

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“…The influence of the problems derived in primary care in the context of crisis, both in terms of lack of health personnel or due to an excessive demand for care, and their impact on emergency care, has already been studied in other contexts [ 36 ]. The improvement in primary care is positioned as a fundamental measure to reduce IEDU [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…An increase in the demand for emergency health care is one of the major challenges facing healthcare systems worldwide [ 1 , 2 ]. The inappropriate use of the emergency department (IEDU)—consisting of the unnecessary use of the resource by patients with no clinical need—affects sustainability, efficiency, and quality of care due to unnecessary resource consumption [ 3 ] and delays in caring for patients who urgently need assistance [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of the COVID-19 Pandemic on Inappropriate Use of the Emergency Department

et al. 2023

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Inappropriate use of the emergency department (IEDU)—consisting of the unnecessary use of the resource by patients with no clinical need—is one of the leading causes of the loss of efficiency of the health system. Specific contexts modify routine clinical practice and usage patterns. This study aims to analyse the influence of COVID-19 on the IEDU and its causes. Methods: A retrospective, cross-sectional study conducted in the emergency department of a high-complexity hospital. The Hospital Emergency Suitability Protocol (HESP) was used to measure the prevalence of IEDU and its causes, comparing three pairs of periods: (1) March 2019 and 2020; (2) June 2019 and 2020; and (3) September 2019 and 2020. A bivariate analysis and multivariate logistic regression models, adjusted for confounding variables, were utilized. Results: In total, 822 emergency visits were included (137 per period). A total prevalence of IEDU of 14.1% was found. There was a significant decrease in IEDU in March 2020 (OR: 0.03), with a prevalence of 0.8%. No differences were found in the other periods. A mistrust in primary care was the leading cause of IEDU (65.1%). Conclusions: The impact of COVID-19 reduced the frequency of IEDU during the period of more significant population restrictions, with IEDU returning to previous levels in subsequent months. Targeted actions in the field of population education and an improvement in primary care are positioned as strategies that could mitigate its impact.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on Inappropriate Use of the Emergency Department

et al. 2023

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“…In most studies, old age and ED boarding were directly associated with prolonged EDLOS [12][13][14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Elderly emergency department boarders’length of stay and risk factors

Wang

Liu

et al. 2023

Preprint

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Study objective: The distribution of Emergency Department Length Of Stay (EDLOS) for young and old emergency department (ED) boarders and its risk factors remain ill-defined, and we attempt to sort it out using organizational data linked at the individual level from a tertiary public teaching hospital at Lanzhou, China. Methods: A retrospective cohort study of ED admitted patients between 1 January 2016 to 31 December 2018 was conducted. The primary outcome was the distribution of EDLOS between the elder (≥65 years) and the younger (17-64 years) and the rate for prolonged EDLOS, defined as≥75th percentile of EDLOS. Secondary outcomes were the possible risk factors. Using Oaxaca-Blinder decomposition to decompose the prolonged EDLOS rate gap between two age groups. Results: A total of 28562 ED presentations were included in the study, and the mean age was 50.92 years (S.D.±17.52). The mean EDLOS for the younger group was 11.5h(S.D.±18) and 13.18h(S.D.±20.82）for the elderly patients. The two age groups differed significantly in prolonged EDLOS rate (P<0.001). 29.13% of elderly patients and 11.5% of younger patients suffered from prolonged EDLOS. The result of multivariable regression suggests excessive medication, MRI inspection, and consultation by specialists from internal medicine or emergency from the inpatient department contribute the most. Results of Blinder-Oaxaca decomposition suggested that characteristic differences can explain nearly two-thirds of the prolonged EDLOS gap between the two age groups, in which organizational differences were the major contributor. Conclusion: Elderly patients had significantly longer EDLOS than their younger counterparts, and organizational factors played a dominant role, which may be overcome through organizational reform.

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“…In Australia, GP care utilization is associated with reduced risk for any emergency department presentations [ 7 ]; and using GP services lowers the rate of potentially preventable hospitalizations in people with diabetes [ 6 ]. In Portuguese, a study shows that having an assigned GP increases the appropriate use of emergency departments by 1% [ 8 ]. In Hungary, GPs motivate participation in cervical cancer screening by 27% of women who initially refused [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Can family doctor system improve health service utilization for patients with hypertension and diabetes in China? A difference-in-differences study

Zhang,

Chen

2024

BMC Health Serv Res

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Background Family doctors, serving as gatekeepers, are the core of primary health care to meet basic health needs, provide accessible care, and improve attainable health. The study objective was to evaluate the impact of the family doctor system on health service utilization among patients with hypertension and diabetes in China. Methods Difference-in-Differences (DID) models are constructed to estimate the net effect of the family doctor system, based on the official health management records and medical insurance claim data of patients with hypertension and diabetes in an eastern city of China. Results The family doctor system significantly increases follow-up visits (hypertension patients coef. = 0.13, diabetes patients coef. = 0.08, both p < 0.001) and outpatient visits (hypertension patients coef. = 0.08, diabetes patients coef. = 0.05, both p < 0.001) among the contracted compared to the non-contracted. The proportion of outpatient visits in community health centers among the contracted significantly rose (hypertension patients coef. = 0.02, diabetes patients coef. = 0.04, both p < 0.001) due to significantly more outpatient visits in community health centers and fewer in secondary and tertiary hospitals. It also significantly mitigates the increase in inpatient admissions among hypertension patients but not among diabetes patients. Conclusions The examined family doctor system strengthens primary care, both by increasing follow-up visits and outpatient visits and promoting a rationalized structure of outpatient utilization in China.

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The impact of primary health care reform on hospital emergency department overcrowding: Evidence from the Portuguese reform

Cited by 12 publications

References 32 publications

Impact of the COVID-19 Pandemic on Inappropriate Use of the Emergency Department

Impact of the COVID-19 Pandemic on Inappropriate Use of the Emergency Department

Elderly emergency department boarders’length of stay and risk factors

Can family doctor system improve health service utilization for patients with hypertension and diabetes in China? A difference-in-differences study

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