Use Of Emergency Care Research Articles

Health Care Utilization and Costs Associated With Pediatric Chronic Pain

The population prevalence of pediatric chronic pain is not well characterized, in part because of a lack of nationally representative data. Previous research suggests that pediatric chronic pain prolongs inpatient stay and increases costs, but the population-level association between pediatric chronic pain and health care utilization is unclear. We use the 2016 National Survey of Children's Health to describe the prevalence of pediatric chronic pain, and compare health care utilization among children ages 0 to 17 years according to the presence of chronic pain. Using a sample of 43,712 children, we estimate the population prevalence of chronic pain to be 6%. In multivariable analysis, chronic pain was not associated with increased odds of primary care or mental health care use, but was associated with greater odds of using other specialty care (odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.62–2.47; P < .001), complementary and alternative medicine (OR = 2.32, 95% CI = 1.79–3.03; P < .001), and emergency care (OR = 1.62, 95% CI = 1.29–2.02; P < .001). In this population-based survey, children with chronic pain were more likely to use specialty care but not mental health care. The higher likelihood of emergency care use in this group raises the question of whether better management of pediatric chronic pain could reduce emergency department use. PerspectiveAmong children with chronic pain, we show high rates of use of emergency care but limited use of mental health care, which may suggest opportunities to increase multidisciplinary treatment of chronic pain.

Primary Care Preparation for Children with Medical Complexity for Emergency Encounters in the Community

It can be difficult to assist children with medical complexities (CMC) in maintaining wellness outside of hospital and emergency department settings. This growing population, with high use of medical technology and specialty care, has created a challenge for community providers who may infrequently care for children with these rare disorders and needs. CMCs have increased hospitalization rates and emergency care use. It is not realistic to believe that emergency health providers will know how to manage every type of CMC when they present for emergency care. Primary care providers (PCPs) may be able to use the medical home to avoid some urgent visits, but when CMC need emergency services, an emergency information form may add great benefit and personalized care. This article assists PCPs in identifying and preparing CMCs and families to successfully interface with emergency services as well as prepare for disaster events. [Pediatr Ann. 2018;47(3):e102-e105.].

Time to first-line (1L) therapy discontinuation in metastatic melanoma (MM).

196 Background: Nivolumab or pembrolizumab monotherapy (N/P) and dabrafenib+trametinib combination therapy (D+T) are currently the most commonly used regimens for the treatment of MM in anti-PD1 and BRAF inhibitor classes, respectively. We describe time to discontinuation of 1L therapy with N/P or D+T in patients (pts) with MM in a real-world setting. Methods: Adults with MM initiated on N/P or D+T in 1L were identified in Truven MarketScan databases (Q1/2014 - Q2/2016; n = 443). Outcomes included (a) distribution of time to 1L discontinuation among pts who discontinued 1L therapy during the study follow-up (reported by year of 1L start) and (b) rates of pts still on 1L therapy at different time points after 1L therapy start ("on treatment" rates) estimated from Kaplan-Meier analyses. Results: Of 443 pts, 243 (55%) were initiated on N/P and 200 (45%) on D+T. Pts initiated on D+T appeared to be younger, with more brain metastases, and higher use of emergency care in the 6 mo prior to 1L therapy start as compared to those initiated on N/P (Table). Time to 1L discontinuation and "on treatment" rates were similar between the treatment groups, with a tendency towards longer time to 1L discontinuation for D+T (Table). Conclusions: This real-world data study showed numerically longer time to 1L discontinuation for pts treated with D+T as compared to N/P, despite higher comorbidity burden. [Table: see text]

Health Literacy and Health Outcomes of Adults in the United States: Implications for Providers

The purpose of this paper is to explore health literacy of adults in the United States and review health outcomes as well as provider implications. Limited health literacy is a serious problem in the United States. Approximately 80 million adults in the United States have limited health literacy, which can adversely affect the quality of their health care. Poor health outcomes are associated with being health illiterate. Evidence shows that limited health literacy is associated with more hospitalizations; greater use of emergency care; lower receipt of mammography screening and influenza vaccine; poorer ability to demonstrate taking medications properly; poorer ability to interpret drug labels and health messages; and, among elderly persons, poorer overall health status and higher mortality rates. Health literacy is essential for patients to be able to take control and manage their own health. The benefits of being health literate include greater patient safety, less hospitalizations, a greater ability to care for oneself, and a greater cost savings to the healthcare system. This paper emphasizes “best practices” recommended by the World Health Organization (WHO),1 The American Medical Association (AMA),2 the Institute of Medicine (IOM),3 the Center for Disease Control (CDC),4 and the Joint Commission (JCAHO) 5 When patients, providers and communities work together to understand and improve health literacy a greater quality of life will result. Today’s health care providers are in a position to make an impact on the health illiteracy epidemic and improve the patient’s understanding about their health and outcomes.

Ultrasound evaluation of inguinoscrotal pain: an imaging-based review for the ultrasonographer

Emergencies involving the inguinal region and scrotum are common and can be caused by a plethora of different causes. In most cases, such conditions have nonspecific symptoms and are quite painful. Some inguinoscrotal conditions have high complication rates. Early and accurate diagnosis is therefore imperative. Ultrasound is the method of choice for the initial evaluation of this vast range of conditions, because it is a rapid, ionizing radiation-free, low-cost method. Despite the practicality and accuracy of the method, which make it ideal for use in emergency care, the examiner should be experienced and should be familiarized with the ultrasound findings of the most common inguinoscrotal diseases. On the basis of that knowledge, the examiner should also be able to make an accurate, direct, precise report, helping the emergency room physician make decisions regarding the proper (clinical or surgical) management of each case. Here, we review most of the inguinoscrotal conditions, focusing on the imaging findings and discussing the critical points for the appropriate characterization of each condition.

Ambulatory Care Use among Patients with Spina Bifida: Change in Care from Childhood to Adulthood

We examined the ambulatory health care visit use of children with spina bifida, adults who transitioned to adult care and adults who continued to seek care in a pediatric setting. We evaluated use during a 1-year period of patients with spina bifida who visited any outpatient medical clinic within an integrated health care system. Patients were categorized as pediatric (younger than 18years) or adult (age 18 or older). Adults were divided into those who did not fully transition to adult care and patients who fully transitioned (adult). Frequency and type of health care use were compared. Subanalysis was performed for patients 18 to 25years old to examine variables associated with successful complete transition to adult care. During 1 year 382 children, 88 patients who did not transition and 293 adult patients with spina bifida had 4,931 clinic visits. Children had greater ambulatory care use (7.25 visits per year) compared to fully transitioned adults (5.33 visits per year, p=0.046). Children more commonly visited surgical clinics (52.3% of visits) and adults more commonly visited medical clinics (48.9%) (p<0.005). Adult transitioned patients were more likely to be female (p=0.004). Of the patients 18 to 25 years old, those who did not transition to adult care had similar outpatient visit types but greater use of inpatient and emergency care than those who transitioned. Children with spina bifida used more ambulatory care than adults and were more likely to visit a surgical specialist. Adult patients with spina bifida who successfully transitioned to adult care were more likely to be female, and patients who failed to transition were more likely to receive more inpatient and emergency care.

Exploring the relationship between general practice characteristics and attendance at Walk-in Centres, Minor Injuries Units and Emergency Departments in England 2009/10\u20132012/2013: a longitudinal study

BackgroundThe UK National Health Service Emergency Departments (ED) have recently faced increasing attendance rates. This study investigated associations of general practice and practice population characteristics with emergency care service attendance rates.MethodsA longitudinal design with practice-level measures of access and continuity of care, patient population demographics and use of emergency care for the financial years 2009/10 to 2012/13. The main outcome measures were self-referred discharged ED attendance rate, and combined self-referred discharged ED, self-referred Walk-in Centre (WiC) and self-referred Minor Injuries Unit (MIU) attendance rate per 1000 patients. Multilevel models estimated adjusted regression coefficients for relationships between patients’ emergency attendance rates and patients’ reported satisfaction with opening hours and waiting time at the practice, proportion of patients having a preferred GP, and use of WiC and MIU, both between practices, and within practices over time.ResultsPractice characteristics associated with higher ED attendance rates included lower percentage of patients satisfied with waiting time (0.22 per 1% decrease, 95%CI 0.02 to 0.43) and lower percentage having a preferred GP (0.12 per 1% decrease, 95%CI 0.02 to 0.21). Population influences on higher attendance included more elderly, more female and more unemployed patients, and lower male life-expectancy and urban conurbation location. Net reductions in ED attendance were only seen for practices whose WiC or MIU attendance was high, above the 60th centile for MIU and above the 75th centile for WiC. Combined emergency care attendance fell over time if more patients within a practice were satisfied with opening hours (−0.26 per 1% increase, 95%CI −0.45 to −0.08).ConclusionPractices with more patients satisfied with waiting time, having a preferred GP, and using MIU and WIC services, had lower ED attendance. Increases over time in attendance at MIUs, and patient satisfaction with opening hours was associated with reductions in service use.

The impact of adverse childhood experiences on health service use across the life course using a retrospective cohort study

ObjectivesThe lifelong health impacts of adverse childhood experiences are increasingly being identified, including earlier and more frequent development of non-communicable disease. Our aim was to examine whether adverse childhood experiences are related to increased use of primary, emergency and in-patient care and at what ages such impact is apparent.MethodsHousehold surveys were undertaken in 2015 with 7414 adults resident in Wales and England using random probability stratified sampling (age range 18–69 years). Nine adverse childhood experiences (covering childhood abuse and household stressors) and three types of health care use in the last 12 months were assessed: number of general practice (GP) visits, emergency department (ED) attendances and nights spent in hospital.ResultsLevels of use increased with increasing numbers of adverse childhood experiences experienced. Compared to those with no adverse childhood experiences, odds (±95% CIs) of frequent GP use (≥6 visits), any ED attendance or any overnight hospital stay were 2.34 (1.88–2.92), 2.32 (1.90–2.83) and 2.67 (2.06–3.47) in those with ≥ 4 adverse childhood experiences. Differences were independent of socio-economic measures of deprivation and other demographics. Higher health care use in those with ≥ 4 adverse childhood experiences (compared with no adverse childhood experiences) was evident at 18–29 years of age and continued through to 50–59 years. Demographically adjusted means for ED attendance rose from 12.2% of 18-29 year olds with no adverse childhood experiences to 28.8% of those with ≥ 4 adverse childhood experiences. At 60–69 years, only overnight hospital stay was significant (9.8% vs. 25.0%).ConclusionsAlong with the acute impacts of adverse childhood experiences on child health, a life course perspective provides a compelling case for investing in safe and nurturing childhoods. Disproportionate health expenditure in later life might be reduced through childhood interventions to prevent adverse childhood experiences.

A review of associated controversies surrounding glucocorticoid use in veterinary emergency and critical care.

To review the literature in human and veterinary medicine regarding the indications for, efficacy of, and controversies surrounding glucocorticoid (GC) administration in the emergency and critical care (ECC) setting, and to provide an overview of the most commonly used synthetic GC formulations. Synthetic GCs vary in GC and mineralocorticoid potency, hypothalamic pituitary axis suppression, duration of action, route of administration, and clinical indication for use. Some of the GC compounds commonly used in human and veterinary ECC include hydrocortisone, prednisone, methylprednisolone, and dexamethasone. GCs are used in human and veterinary ECC for a variety of disorders including anaphylaxis, acute lung injury/acute respiratory distress syndrome, septic shock, and spinal cord injury. Evidence for morbidity or mortality benefit with administration of GC within these populations exists; however, data are sparse and often conflicting. Routine use of GC in some conditions such as trauma, hemorrhagic shock, and traumatic brain injury is likely contraindicated. GC use has been associated with hyperglycemia, pneumonia, urinary tract infection, gastrointestinal ulceration, or increased mortality in some populations.

Enriched Medical Home Intervention Using Community Health Worker Home Visitation and ED Use.

Community health workers (CHWs) have great potential to extend medical home services and reduce emergent health care use, but evidence in pediatrics is scarce. We evaluated the impact of an existing enriched medical home intervention (EMHI) that directly integrates CHWs into emergency department (ED) visits and hospitalizations for pediatric ambulatory care-sensitive conditions (ACSCs). The EMHI group in this prospective cohort study received home visits from trained CHWs to support adherence to recommended care; the comparison group received usual care (UC). Sociodemographic characteristics were compiled from the EMHI database, and ED and hospitalization information was extracted for study participants from a statewide database. The Wilcoxon signed rank test was used to compare ED data and the Wald test was used to compare hospitalization use for ACSCs between the intervention and UC groups after adjusting for different characteristics between groups by using propensity score matching method. The study sample included 922 children (225 intervention, 697 UC). After propensity score matching, the analytic sample included 450 children (225 intervention, 225 UC). After propensity score matching, the intervention group was significantly less likely than the UC group to visit the ED for an ACSC (18.2% vs 35.1%; P = .004). We found no differences in ACSC hospitalizations between the 2 groups. Our findings suggest that EMHIs using trained CHWs may be a cost-effective model to reduce preventable ED utilization, especially among vulnerable children.

Exploring disparities in hospital use for physical healthcare in those with mental ill health in England 2009/10 to 2013/14

Introduction: One in 6 adults has a mental health problem, and 1 in 100 have a severe mental illness (SMI)1. Premature mortality rates are higher in those with mental ill health and is attributable to a range of factors including higher prevalence of preventable risk factors for chronic disease, and poorer access to physical healthcare3,4 5. Recently in England, there has been a policy focus to achieve ‘parity of esteem’ for physical and mental health, but it is unclear if this aspiration is reflected in practice. The aims of this study were to examine levels of hospital activity for physical health needs in those with mental ill health in England, and examine differences compared to those without mental ill health, over time. Methods : We used hospital data for England (hospital episode statistics) to identify individuals aged 18 to 75 years with an indication of mental ill health in each year between 2009/10 and 2013/14. Those with mental ill health (MH Cohort) were defined as using hospital services with a primary diagnosis (ICD-10 codes ‘F’ chapter) or under then main specialty (starting with ‘7’) of mental health. SMI was defined as a primary diagnosis of schizophrenia, bipolar disorder or psychoses (ICD-10 codes: ‘F20-29’ and ‘F30-31’). A comparator cohort (PH cohort) were those who had not used hospital services for mental ill health in each year nor previous two years. Crude hospital activity rates were calculated for the MH and PH cohorts, from 2009/10 to 2013/14. Hospital activity relating to mental or physical health was identified using the main speciality recorded during contact with the hospital services. We also examined rates of common inpatient procedures for physical health conditions, and characteristics of these admissions, e.g. planned versus emergency care, and length of stay. Results : We identified 545,759 patients in the MH cohort and 12.5M in the PH cohort in 2013/14. The MH cohort were younger and more deprived. Using hospital data, 21.3% of MH cohort had at least one other long-term condition recorded (in addition to mental ill health) compared to 23.7% of PH cohort. In 2013/14, compared to the PH cohort, the MH and SMI cohorts had higher A&E attendance rates (RR 3.2 and 3.3 respectively), emergency inpatient admissions (RR 4.9 and 6.7), and emergency admission rates for ambulatory care sensitive conditions (MH cohort only RR 3.6). From 2009/10 to 2013/14, the difference in emergency care use between those with mental ill health and those without, increased. Deprivation was strongly associated with emergency care in both the MH and PH cohorts, with the more deprived people using the most emergency hospital care. In 2013/14, the MH cohort also had lower planned inpatient admissions (RR 0.9), but higher rates or outpatient activity (RR 1.7). There was no change in the difference in planned care over the study period. In the MH cohort, 80.9% of inpatient admissions, and 48.6% of outpatient appointments were for physical health conditions (2013/14). For some common physical procedures a higher proportion were carried out as an emergency in the MH cohort compared to the PH cohort (eg upper digestive tract procedures (21.0% and 4.9% respectively)), and had a longer length of stay (e.g. hip replacement mean length of stay 11.4 and 4.7 days respectively). Discussion : We found higher rates of emergency care use and potentially preventable admissions in those with mental ill health. We found that those with mental ill health were more likely to have an emergency rather than planned admission for common inpatient procedures, be admitted overnight and stay longer in hospital. Given the complex mental and physical health needs in this vulnerable population, high emergency hospital care may be expected. But in this study we found high levels of potentially avoidable admissions and high rates of emergency admissions for physical health needs, which may reflect poor identification/management of physical health in those with mental ill health. Conclusion : This study highlights consistent disparities in the use of hospital services for physical health care in those with mental ill health in England over the past 5 years. A key limitation is that the analysis only reflects acute care activity, and more could be understood by linking to other care settings (eg primary care). However, if the gap in hospital care between those with mental ill health and those without continues further, then the national goal to break down barriers between mental and physical health and achieve parity of esteem by 2020 is unlikely to be realised.

Development and Testing of Shared Decision Making Interventions for Use in Emergency Care: A Research Agenda

Decision aids are evidenced-based tools designed to increase patient understanding of medical options and possible outcomes, facilitate conversation between patients and clinicians, and improve patient engagement. Decision aids have been used for shared decision making (SDM) interventions outside of the ED setting for more than a decade. Their use in the ED has only recently begun to be studied. This article provides background on this topic and the conclusions of the 2016 Academic Emergency Medicine consensus conference SDM in practice work group regarding "Shared Decision Making in the Emergency Department: Development of a Policy-Relevant, Patient-Centered Research Agenda." The goal was to determine a prioritized research agenda for the development and testing of SDM interventions for use in emergency care that was most important to patients, clinicians, caregivers, and other key stakeholders. Using the nominal group technique, the consensus working group proposed prioritized research questions in six key domains: 1) content (i.e., clinical scenario or decision area), 2) level of evidence available, 3) tool design strategies, 4) risk communication, 5) stakeholders, and 6) outcomes.

Can continuity of primary care decrease emergency care use? A nested case-control study

BackgroundNational Health Service emergency departments have been under considerable pressure. Many patients presenting to emergency departments could be managed in primary care, suggesting that aspects of general practice might be associated with unplanned hospital admission. Recently a government scheme introduced the concept of a named GP (general practitioner) responsible for the care of patients aged 75 and older to reduce unplanned hospital admission. We aimed to investigate whether better continuity of care is associated with lower risk of emergency hospital admission. MethodsWe used records from 10 000 patients aged 65 years and over randomly selected from the Clinical Practice Research Datalink, linked with Hospital Episode Statistics. Using a nested-case control approach, we identified 769 patients with an emergency hospital admission between April 1, 2012, and March 31, 2014, and at least two GP consultations in the previous 2 years, of which the last was within 30 days before hospital admission. 2123 controls were matched on age group, last consultation within the same time-period as the case, and GP practice to account for practice composition, deprivation level, and services such as out-of-hours. For both cases and controls we calculated two longitudinal measures of continuity of care—namely, Bice and Boxerman's index, which quantifies the extent to which the patient saw the same GP, and proportion of times seen by an index GP (ie, last GP seen before admission). Conditional logistic regression models were applied to estimate the odds ratio (OR) associated with continuity of care, adjusting for sex, number of consultations, previous hospital admission, and a range of comorbidities. FindingsBoth the Bice and Boxerman and the appointed index GP measures showed a graded inverse association between lower continuity of care and higher risk of emergency hospital admission (OR for those experiencing the least continuity of care 2·1 [95% CI 1·3–3·2] and 2·3 [1·6–2·9], respectively, compared with those who always saw the same GP). InterpretationBetter continuity of care might reduce emergency hospital admission. More research is needed to understand this association including distinguishing between GP-referred emergency hospital admissions and admissions through the emergency department. Such an analysis requires a bigger data set. FundingNational Institute for Health Research School of Primary Care Research grant (round 9, project number 246).

Sarcopenia Screened With SARC-F Questionnaire Is Associated With Quality of Life and 4-Year Mortality

ObjectivesThere is no gold standard in diagnosing sarcopenia. We aimed to assess the validity of screening sarcopenia using SARC-F (sluggishness, assistance in walking, rise from a chair, climb stairs, falls). DesignProspective cohort study. SettingCommunity hospital in Taiwan. ParticipantsCommunity-dwelling senior citizens. MeasurementsParticipants were interviewed with a structured questionnaire annually. The questionnaire items were recoded into the 5 items of SARC-F (sluggishness, assistance in walking, rise from a chair, climb stairs, falls). In the baseline year, a subgroup was tested for grip strength and body composition. Healthcare utilization and mortality were based on self-report and hospital records. Our main outcome was 4-year mortality. Secondary outcomes included hospitalization, emergency care use, and quality of life (QOL) measured using the CASP-12 scale (control, autonomy, self-realization, pleasure (control, autonomy, self-realization, pressure). ResultsThere were 670 participants. The mean age was 76.1 (standard deviation 6.36). One-half were men (n = 340, 50.7%). The prevalence of sarcopenia was 6.1% (n = 41). SARC-F scores were inversely associated with grip strength (P = .001) and skeletal muscle composition (P = .045). Participants with sarcopenia were mostly women (P = .005) and older (P < .001). In univariate analysis, sarcopenia was associated with 1- to 4-year mortalities (P = .033, .001, .001, <.001, respectively), overall hospitalization (P = .004), overall emergency care use (P = .017), and QOL (P < .001). In multivariate model, sarcopenia [odds ratio (OR) 7.35, 95% confidence interval (CI) 2.67-20.18], age (OR 1.19, 95% CI 1.09-1.29 for each year), and taking vitamin D supplements (OR 0.29, 95% CI 0.11-0.74) were factors associated with mortality. ConclusionsSarcopenia screened using SARC-F was associated with subsequent QOL, overall hospitalization, overall emergency care use, and 4-year mortality. SARC-F can serve as a quick screening tool of sarcopenia.

Child Health Systems in the United Kingdom (England)

Child health in the United Kingdom has improved markedly over recent decades but has failed to match health gains and reductions in mortality achieved by other European countries. Child poverty and inequalities are rising in the United Kingdom. The National Health Service (NHS) is a universally accessible health service, funded by taxation and is free at the point of use. The NHS is undergoing substantial reform, aiming to improve care quality and experience, meet rising demands, and contain costs. The NHS is struggling to balance access with expertise for urgent and unscheduled care. There is increasing use of urgent and emergency care, and there are unexplained variations in outcomes. Quality of care for children and young people with chronic and long-term conditions, including transition services, is variable and sometimes poor. Many determinants of noncommunicable conditions are worsening. Key achievements include a universal service free at the point of use, providing generally accessible, and equitable care. Key challenges include increasing fragmentation of services, insufficient emphasis on preventive care, achieving an effective balance between access and expertise of care for children, and improving child health and well-being outcomes despite generally high quality inputs and high levels of spending.

The Effects of Insurance Status and Medical Need on Community-Based Health Care Access Among Jail Detainees With Serious Mental Illnesses

The present study assessed factors affecting patterns of pre-incarceration medical service access and use among jail detainees with serious mental illnesses and co-occurring substance use disorders. Multivariable logistic and negative binomial models controlling for socio-demographic and psychodiagnostic factors assessed the extent to which insurance status and medical need significantly affected having a regular health care place/provider and number of emergency and non-emergency care visits in the year prior to detention. The results indicated having insurance was associated with decreased emergency care use and increased access to routine medical care. In comparison with insurance status, medical need was a more important determinant of the frequency of both routine and emergency medical care visits. We believe the results broadly support Medicaid expansion under the Affordable Care Act, as well as its provisions for medical homes for offender populations.

A Cross-Sectional Study of Musculoskeletal Health Literacy in Patients With Carpal Tunnel Syndrome.

Background: Approximately 33% of Americans have inadequate health literacy, which is associated with infrequent use of preventative services, increased hospitalization and use of emergency care, and worse control of chronic diseases. In this study, the Literacy in Musculoskeletal Problems (LiMP) questionnaire was used to evaluate the prevalence of limited musculoskeletal literacy in patients undergoing carpal tunnel release (CTR), as these individuals may be at increased risk of inferior outcomes. Methods: This cross-sectional study included individuals older than or equal to 18 years of age who were scheduled for elective CTR. Participants completed a demographic survey and the LiMP questionnaire during their preoperative office visit. The prevalence of limited health literacy was determined, with chi-square analysis used to determine the influence of demographic parameters. Results: The mean LiMP score was 6 ± 1.40. Limited musculoskeletal literacy was seen in 34% of participants (22/65). Analysis identified race (Caucasian), gender (female), higher education levels (≥college), current or prior employment in a health care field, and a prior physician visit for a non-carpal tunnel musculoskeletal complaint as being associated with higher literacy rates. Conclusions: Approximately one-third of patients scheduled for elective CTR have limited musculoskeletal literacy and may lack the necessary skills required for making informed decisions regarding their care. This is concerning, as CTR is performed in the United States on roughly 500 000 individuals annually, at an estimated cost of 2 billion dollars. The identification of those most at risk is thus crucial, and will facilitate the development of education campaigns and interventions geared toward those who are most vulnerable.

Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening

Restricted access to primary care can lead to avoidable, excessive use of expensive emergency care. Since 2013, partly to alleviate overcrowding at the Accident & Emergency (A&E) units of hospitals, the UK has been piloting 7-day opening of General Practitioner (GP) practices to improve primary care access for patients. We evaluate the impact of these pilots on patient attendances at A&E. We estimate that 7-day GP opening has reduced A&E attendances by patients of pilot practices by 9.9% with most of the impact on weekends which see A&E attendances fall by 17.9%. The effect is non-monotonic in case severity with most of the fall occurring in cases of moderate severity. An additional finding is that there is also a 9.9% fall in weekend hospital admissions (from A&E) which is entirely driven by a fall in admissions of elderly patients. The impact on A&E attendances appears to be bigger among wealthier patients. We present evidence in support of a causal interpretation of our results and discuss policy implications.

Global healthcare use by immigrants in Spain according to morbidity burden, area of origin, and length of stay.

BackgroundThe healthcare of immigrants is an important aspect of equity of care provision. Understanding how immigrants use the healthcare services based on their needs is crucial to establish effective health policy.MethodsThis retrospective, observational study included the total population of Aragon, Spain (1,251,540 individuals, of whom 11.9 % were immigrants). Patient-level data on the use of primary, specialised, hospital, and emergency care as well as prescription drug use in 2011 were extracted from the EpiChron Cohort and compared between immigrants and nationals. Multivariable standard or zero-inflated negative binomial regression models were generated, adjusting for age, sex, length of stay, and morbidity burden.ResultsThe annual visit rates of immigrants were lower than those of nationals for primary care (3.3 vs 6.4), specialised care (1.3 vs 2.7), planned hospital admissions/100 individuals (1.6 vs 3.8), unplanned hospital admissions/100 individuals (2.7 vs 4.7), and emergency room visits/10 individuals (2.3 vs 2.8). Annual prescription drug costs were also lower for immigrants (€47 vs €318). These differences were only partially attenuated after adjusting for age, sex and morbidity burden.ConclusionIn a universal coverage health system offering broad legal access to immigrants, the global use of healthcare services was lower for immigrants than for nationals. These differences may be explained in part by the healthy migration effect, but also reveal possible inequalities in healthcare provision that warrant further investigation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3127-5) contains supplementary material, which is available to authorized users.

Gesundheit von Kindern und Jugendlichen aus Familien mit ungesichertem Aufenthaltsstatus im Vergleich zu Kindern mit und ohne Migrationshintergrund: Auswertung der KiGGS-Daten 2003–06

The health of children and adolescents from families with insecure residence status could be poorer compared to other children with permanent residence permits in Germany due to exposure before and during flight. Their insecure residence status and their comparably low social status in the destination country may contribute towards access barriers to health care. However, selection effects might also lead to better health compared to other children in the destination country. This study compares the health status of children and adolescents with insecure residence status to that of other children with and without migration background in Germany. We use data from the Health Interview and Examination Survey for Children and Adolescents (KiGGS). In multivariable logistic regression models we analyze the associations between children's residence status and their subjective and mental health, as well as their utilization of emergency services and vaccination status while adjusting for the children's social status and migration background. Among 17,245 children, 197 (1.1 %) had an insecure residence status. Adjusting only for age and sex, an insecure residence status is associated with poorer subjective health (OR=3.12 (2.07-4.94)), mental problems (OR=1.83 (1.16-2.87)), an incomplete vaccination status (OR=2.0 (1.33-3.0)) and the use of emergency health services (OR=2.28 (1.2-4.36)). After adjusting also for social and migration status, only the association with the use of emergency care remains significant (OR=2.53 (1.18-5.43)). This association possibly indicates barriers to the use of regular primary care services, which requires further research.