Article

Emergency Department and Walk-in Clinic Use in Models of Primary Care Practice with Different After-Hours Accessibility in Ontario.

Assistant Professor, Department of Family Medicine, McMaster University, Hamilton, ON.
Healthcare policy = Politiques de sante 09/2008; 4(1):73-88. pp.73-88
Source: PubMed

ABSTRACT INTRODUCTION: New models of primary healthcare delivery recently implemented in Ontario are designed to improve after-hours accessibility. This study examined whether the six-month prevalence of emergency department and walk-in clinic use differed among patients of eight Family Health Network (FHN), 16 Family Health Group (FHG) and 12 fee-for-service (FFS) physicians in one city. METHODS: Patients over one year of age who had visited their family doctor in the previous 12 months (n=9,373) were randomly selected from computerized records. A mailed survey asked about urgent health problems in the previous six months and use of health services for those problems. A generalized estimating equation approach was used to compare the proportions of patients using the emergency department and walk-in clinic in the FHN versus other practice types, adjusting for clustering of patients within practices. Multiple imputation was used to impute data for non-respondents and missing items on the surveys. RESULTS: The response rate was 62.3% (5,884/9,373). Six-month prevalence of emergency department use was 11.4% (199/1,753) among the FHN practices, 15.7% (347/2,236) among the FHG practices (odds ratio [OR] = 1.47; 95% confidence interval [CI] = 1.21-1.80) and 14.3% (252/1,779) among the FFS practices (OR=1.33; 95% CI=1.12-1.59). Six-month prevalence of walk-in clinic use was 1.7% (30/1,723) among the FHN practices versus 1.9% (41/2,236) in the FHG practices (OR=1.07; 95% CI=0.68-1.68) and 3.4% (59/1,779) among the FFS practices (OR=2.08; 95% CI=1.41-3.08). The statistical significance of results was unchanged using multiple imputation. CONCLUSIONS: Patients' use of the emergency department and walk-in clinics differs across primary care practice models with different after-hours accessibility arrangements and incentives.

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    Article: Chronically ill Canadians' experiences of being unattached to a family doctor: a qualitative study of marginalized patients in British Columbia.
    Valorie A Crooks, Gina Agarwal, Angela Harrison
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    BMC Family Practice 07/2012; 13:69. · 1.80 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

12 fee-for-service
 
16 Family Health Group
 
95% confidence interval [CI]
 
different after-hours accessibility arrangements
 
emergency department
 
emergency department use
 
Family Health Network
 
health services
 
mailed survey
 
New models
 
odds ratio [OR]
 
previous 12 months
 
primary care practice models
 
primary healthcare delivery
 
response rate
 
Six-month prevalence
 
urgent health problems
 
walk-in clinic
 
walk-in clinic use
 
walk-in clinics