Date Published: September 6, 2016
Publisher: Public Library of Science
Author(s): Sanjay Basu, Russell S. Phillips
Abstract: Sanjay Basu and Russell Phillips discuss the findings from Whittaker and colleagues on the link between extending primary care hours and emergency department utilization.
Partial Text: Surprisingly few studies have carefully examined whether emergency department utilization has been reduced by increasing access to primary care. Per a 2013 systematic review of international studies, most research on the question has been poorly designed . Many prior studies simply correlated differences in emergency department utilization with differences in primary care access—a study design confounded by differences in patient composition between low- and high-access groups. Other studies compared emergency department utilization among patients before versus after interventions to increase primary care access, which makes the results highly subject to confounding by external influences, such as changes in the economy (as unemployment affects care-seeking) or even seasonality (e.g., increased utilization in influenza season).
For health services researchers, the most informative results may be found in the authors’ careful process evaluation. Providing enhanced primary care access was costly and produced a heavy workload. An average of 35 additional hours of appointments per week were made available per practice in the treatment group, resulting in ~33,000 additional primary care appointments booked at primary care practices and US$4.8 million in costs. By contrast, about 11,000 emergency department visits were averted, which would have cost ~US$1.1 million. Hence, expanding access to primary care did not result in a cost savings. The intervention may still be cost-effective, which requires longer-term data on health outcomes.