Effect of Access to After-Hours Primary Care on the Association Between Home Nursing Visits and Same-Day Emergency Department Use.
After-Hours Care
/ methods
Aged
Aged, 80 and over
Cross-Over Studies
Emergency Service, Hospital
/ statistics & numerical data
Female
Health Services Accessibility
/ statistics & numerical data
Home Care Services
/ statistics & numerical data
House Calls
/ statistics & numerical data
Humans
Male
Ontario
Patient Acceptance of Health Care
/ statistics & numerical data
Primary Health Care
/ methods
Retrospective Studies
after-hours care
health services for the aged
home care services
primary health care
Journal
Annals of family medicine
ISSN: 1544-1717
Titre abrégé: Ann Fam Med
Pays: United States
ID NLM: 101167762
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
25
09
2019
revised:
29
01
2020
accepted:
05
02
2020
entrez:
15
9
2020
pubmed:
16
9
2020
medline:
9
7
2021
Statut:
ppublish
Résumé
Previous work has demonstrated that home care patients have an increased risk of visiting the emergency department after a home nursing visit on the same day. We investigated whether this association is modified by greater access to after-hours primary care. We conducted a population-based case-crossover study of home care patients in Ontario, Canada in 2014-2016. Emergency department visits after 5:00 pm were selected as case periods and matched, within the same patient, to control periods within the previous week. The association between home nursing visits and same-day emergency department visits was estimated with conditional logistic regression. Access to after-hours primary care, measured on the patient and practice level, was tested for effect modification using an interaction term approach. Analysis was performed separately for all emergency department visits and a less urgent subset not admitted to hospital. A total of 11,840 patients contributed cases to the analysis. Patients with a history of after-hours primary care use had a smaller increased risk of a same-day after-hours emergency department visit (OR = 1.18; 95% CI, 1.06-1.30) compared with patients with no after-hours care (OR = 1.31; 95% CI, 1.25-1.39). The modifying effect was stronger among emergency department visits not admitted to hospital (OR = 1.11; 95% CI, 0.97-1.28 vs OR = 1.41; 95% CI, 1.31-1.51). Greater access to after-hours primary care reduced the risk of less-urgent emergency department use associated with home nursing visits. These findings suggest increasing access to after-hours primary care could prevent some less-urgent emergency department visits.
Identifiants
pubmed: 32928756
pii: 18/5/406
doi: 10.1370/afm.2571
pmc: PMC7489957
doi:
Types de publication
Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
406-412Subventions
Organisme : CIHR
ID : 148933
Pays : Canada
Informations de copyright
© 2020 Annals of Family Medicine, Inc.
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