Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland. Corinne.Chmiel@usz.ch
Abstract
BACKGROUND:
Emergency Departments (ED) in Switzerland are faced with increasing numbers of patients seeking non-urgent treatment. The high rate of walks-ins with conditions that may be treated in primary care has led to suggestions that those patients would best cared for in a community setting rather than in a hospital. Efficient reorganisation of emergency care tailored to patients needs requires information on the patient populations using the various emergency services currently available. The aim of this study is to evaluate the differences between the characteristics of walk-in patients seeking treatment at an ED and those of patients who use traditional out-of-hours GP (General Practitioner) services provided by a GP-Cooperative (GP-C).
METHODS:
In 2007 and 2009 data was collected covering all consecutive patient-doctor encounters at the ED of a hospital and all those occurring as a result of contacting a GP-C over two evaluation periods of one month each. Comparison was made between a GP-C and the ED of the Waid City Hospital in Zurich. Patient characteristics, time and source of referral, diagnostic interventions and mode of discharge were evaluated. Medical problems were classified according to the International Classification of Primary Care (ICPC-2). Patient characteristics were compared using non-parametric tests and multiple logistic regression analysis was applied to investigate independent determinants for contacting a GP-C or an ED.
RESULTS:
Overall a total of 2974 patient encounters were recorded. 1901 encounters were walk-ins and underwent further analysis (ED 1133, GP-C 768). Patients consulting the GP-C were significantly older (58.9 vs. 43.8 years), more often female (63.5 vs. 46.9%) and presented with non-injury related medical problems (93 vs. 55.6%) in comparison with patients at the ED. Independent determining factors for ED consultation were injury, male gender and younger age. Walk-in distribution in both settings was equal over a period of 24 hours and most common during daytime hours (65%).Outpatient care was predominant in both settings but significantly more so at the GP-C (79.9 vs. 85.7%).
CONCLUSIONS:
We observed substantial differences between the two emergency settings in a non gate-keeping health care system. Knowledge of the distribution of diagnoses, their therapy, of diagnostic measures and of the factors which determine the patients' choice of the ED or the GP-C is essential for the efficient allocation of resources and the reduction of costs.
Distribution of ICPC chapters presenting at the ED or GP-C. The GP-C dealt mainly with problems related to respiratory (Chapter R) and general complaints (Chapter A) (26.8% and 15.5%), as well as with musculoskeletal problems and gastrointestinal infections (Chapter L and D) (15.0 and 14.3%). Musculoskeletal- (Chapter L) and skin related problems (chapter S) were most common in walk-ins at the ED with a prevalence of 32.7%, and 28.4%, respectively.
BMC Health Serv Res. BMC Health Serv Res;11:94-94.
Figure 4
Seasonal distribution of Infections at the GP-C. Infection related problems presented in the GP-C showed seasonal variation with regard to the affected organ system. In winter, infections of the respiratory system were more common (70.9%), in summer gastrointestinal infections (34.5%) predominated
BMC Health Serv Res. BMC Health Serv Res;11:94-94.
Figure 1
Study flow. Study flow of different phases of data collection at the ED as well as GP-C from August 17 2007 until September 26 2009. In total 2206 ED and 768 GP-C encounters were registered. 1073 of the ED encounters were non walk-ins. All the patients consulting the GP-C were walk-ins. Out of the 1133 walk-ins at the ED a random sample of 257 (22.7%) encounters were coded according to ICPC. All of the 768 (100%) encounters in the GP-C were coded.
BMC Health Serv Res. BMC Health Serv Res;11:94-94.
Figure 3
Distribution of ICPC components presenting at the ED or GP-C. Injuries related to the musculoskeletal system and the skin (Chapter L and S) were the most common diagnoses in ED walk-in patients (45.5%). At the GP-C Infections (34.3%) and other diagnoses (38.9%) predominated.
BMC Health Serv Res. BMC Health Serv Res;11:94-94.
Figure 5
Musculoskeletal problems, distribution at the ED or GP-C. Musculoskeletal problems (chapter L) were frequent at the ED as well as the GP-C. At the ED the diagnose was mainly due to the component injury (69.0%), at the GP-C mainly due to component other diagnoses (69.0%), mostly comprised of lower back pain.
No comments:
Post a Comment