Predictors of emergency department referral in patients using out-of-hours primary care services

6533b826fe1ef96bd12846c2

RESEARCH PRODUCT

Predictors of emergency department referral in patients using out-of-hours primary care services

Guglielmo Sergi Stefano Traversa Irene De Ronch Nicola Veronese Loris Tonon Marco Solmi Maria Paola Scapinello Gianluca Lollo Andrea Posocco Iginio Tomaselli Francesco Castrogiovanni Vincenzo Zambianco

subject

Male Multivariate analysis Referral Population Context (language use)Emergency department; Gate-keeping; Out-of-hours primary care Health Services Accessibility Out-of-hours primary care 03 medical and health sciences 0302 clinical medicine After-Hours Care Gate-keeping Humans Medicine 030212 general & internal medicine education Referral and Consultation Retrospective Studies education.field_of_study Primary Health Care business.industry Emergency department 030503 health policy & services Health Policy Age Factors Retrospective cohort study Overcrowding Emergency department Odds ratio Middle Aged medicine.disease Nursing Homes Italy Female Medical emergency Emergency Service Hospital 0305 other medical science business

description

Background Out of hours (OOH) doctors could manage many cases limiting the inappropriate accesses to ED. However the possible determinants of referral to ED by OOH doctors are poorly studied. We aimed to characterize patients referred from the OOH to ED service in order to explore the gate-keeping role of OOH service for hospital emergency care and to facilitate future research in improving its cost-effectiveness. Methods A retrospective study was made through data collection of 5217 contacts in a local OOH service in the North-East of Italy (from 10/01/2012 to 03/31/2013). Results Only 8.7% (=454 people) of the total contacts were referred to ED. In the multivariate analysis, the significant predictors of being sent to ED were: age; residence in nursing home (odds ratios (OR) = 2.00, 95%CI: 1.30–3.10); being visited by a OOH physician (OR = 2.64, 95%CI: 2.09–3.34). Taking infections as reference, cardiovascular diseases (OR = 18.31, 95%CI: 12.01–27.90), traumas (OR = 8.75, 95%CI: 5.36–14.26) and gastrointestinal conditions (OR = 7.69, 95%CI: 4.70–11.91) increased the probability to be referred to ED. Conclusions OOH service addresses several common medical conditions in community-dwelling and in nursing home context, supporting its filtering function for the ED access. The main reasons of ED access could be a crucial aspect in general population education in order to avoid the overcrowding of the ED. © 2016 Elsevier Ireland Ltd

year	journal	country	edition	language
2016-01-01

10.1016/j.healthpol.2016.07.018 http://hdl.handle.net/11577/3196052