Which features of primary care affect unscheduled secondary care use? A systematic review
Open Access
Abstract
Objectives To conduct a systematic review to identify studies that describe factors and interventions at primary care practice level that impact on levels of utilisation of unscheduled secondary care. Setting Observational studies at primary care practice level. Participants Studies included people of any age of either sex living in Organisation for Economic Co-operation and Development (OECD) countries with any health condition. Primary and secondary outcome measures The primary outcome measure was unscheduled secondary care as measured by emergency department attendance and emergency hospital admissions. Results 48 papers were identified describing potential influencing features on emergency department visits (n=24 studies) and emergency admissions (n=22 studies). Patient factors associated with both outcomes were increased age, reduced socioeconomic status, lower educational attainment, chronic disease and multimorbidity. Features of primary care affecting unscheduled secondary care were more complex. Being able to see the same healthcare professional reduced unscheduled secondary care. Generally, better access was associated with reduced unscheduled care in the USA. Proximity to healthcare provision influenced patterns of use. Evidence relating to quality of care was limited and mixed. Conclusions The majority of research was from different healthcare systems and limited in the extent to which it can inform policy. However, there is evidence that continuity of care is associated with reduced emergency department attendance and emergency hospital admissions.Keywords
This publication has 56 references indexed in Scilit:
- Reducing Heart Failure Admission Rates in England 2004–2011 are Not Related to Changes in Primary Care Quality: National Observational StudyEuropean Journal of Heart Failure, 2013
- Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based StudyPLOS ONE, 2013
- What aspects of primary care predict emergency admission rates? A cross sectional studyBMC Health Services Research, 2013
- An extension in eligibility for free primary care and avoidable hospitalisations: A natural experimentSocial Science & Medicine, 2011
- Hospitalizations for Ambulatory Care Sensitive Conditions and Quality of Primary CareMedical Care, 2011
- Does Higher Quality of Diabetes Management in Family Practice Reduce Unplanned Hospital Admissions?Health Services Research, 2010
- Distances to Emergency Department and to Primary Care Provider’s Office Affect Emergency Department Use in ChildrenAcademic Emergency Medicine, 2009
- Community Characteristics Affecting Emergency Department Use by Medicaid EnrolleesMedical Care, 2009
- Primary Care Quality and Subsequent Emergency Department Utilization for Children in Wisconsin MedicaidAcademic Pediatrics, 2009
- Can Primary Care Visits Reduce Hospital Utilization Among Medicare Beneficiaries at the End of Life?Journal of General Internal Medicine, 2008