Improving Access to After-Hours Primary Care Cuts ED Visits

TUESDAY, Jan. 19, 2021 (HealthDay News) — Incentivizing primary care physicians to provide services after hours is associated with a reduction in less urgent visits to the emergency department, according to a study published online Jan. 18 in CMAJ, the journal of the Canadian Medical Association.

Michael Hong, from Western University in London, Ontario, Canada, and colleagues analyzed a retrospective cohort of a random sample of Ontario residents from April 2002 to March 2006 (586,534 patients) and a subcohort of 201,594 patients followed from April 2005 to March 2016. Patient and primary care physician data were linked to emergency department visit data.

The researchers found that introduction of the after-hours premium was associated with a reduction of 1.26 less urgent visits to the emergency department per 1,000 patients per month after controlling for patient and physician characteristics, seasonality, and time-invariant patient confounding factors. Most of this decrease was in after-hours visits compared with visits during regular hours. The monthly reduction in less urgent visits to the emergency department was in the range of −1.24 to −1.16 per 1,000 patients in sensitivity analyses. There was an association noted between subsequent increases in the after-hours premium and a small reduction in less urgent visits to the emergency department.

“Interventions to reduce potentially avoidable emergency department visits are of considerable interest to policy-makers; the use of incentives to promote access to after-hours primary care and divert patients away from the emergency department in a cost-effective manner is one policy option to consider,” the authors write.

Abstract/Full Text