%0 Journal Article
%T The Impact on Emergency Department Utilization and Patient Flows after Integrating with a General Practitioner Cooperative: An Observational Study
%A W. A. M. H. Thijssen
%A M. Wijnen-van Houts
%A J. Koetsenruijter
%A P. Giesen
%A M. Wensing
%J Emergency Medicine International
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/364659
%X Introduction. A new model, an emergency care access point (ECAP) for after-hours emergency care, is emerging in The Netherlands. This study assessed the effect on emergency department (ED) utilization and patient flows. Methods. Routinely recorded clinical ED patient data, covering a six-year period, was collected. Segmented regression analysis was used to analyze after-hours changes over time. Results. 59.182 patients attended the ED before the start of the ECAP and 51.513 patients after, a decrease of 13%. Self-referred ED patients decreased 99.5% (OR 0.003; 95% CI 0.002每0.004). Referred patients increased by 213.4% and ED hospital admissions increased by 20.2%. A planned outpatient follow-up increased by 5.8% (OR 1.968 95% CI 1.870每2.071). The latter changed from fewer contacts to more contacts (OR 1.015 95% CI 1.013每1.017). Consultations at the regional genereral practitioner cooperative (GPC) increased by 26.0% (183.782 versus 232.246). Conclusion. ECAP implementation resulted in a decrease in ED utilization, a near absence of self-referring patients, and a higher probability of hospital admission and clinical follow-up. This suggests either an increase of ED patients with a higher acuity or a lower threshold of admitting referred patients compared to self-referred patients. Overall, increased collaboration with after-hours primary care and emergency care seemed to optimize ED utilization. 1. Introduction Organizing after-hours care is an important challenge in many countries. After-hours care is provided between 5ˋp.m. and 8ˋa.m., on weekends and national holidays. In most western countries emergency departments (EDs) are confronted with overcrowding, while general practitioners (GPs) are not all easily accessible, especially after hours. Differences in national healthcare systems have a noticeable effect on redirecting patients to primary care services. In the United States, studies show an increase of 23每27% in ED visits between 1997 and 2008 [1, 2]. Simultaneously, delivering primary care access after hours decreased from 40% of the GPs in 2006 to 29% in 2009 and different models exist [3每5]. In western Europe, the GP plays a significant role in providing after-hours care, with 77% of the GPs in Italy, 89% in the UK, and 97% in The Netherlands providing after-hours arrangements [3]. Across Europe, different models of after-hours primary care exist, varying from local rotation groups to large General Practitioner Cooperatives (GPCs) [6, 7]. Despite good primary care access, high and rising ED visits are also an issue in Europe [8]. In the Dutch
%U http://www.hindawi.com/journals/emi/2013/364659/