Urgent care centres reduce emergency department and primary care same-day visits: a natural experiment

TY - JOUR

T1 - Urgent care centres reduce emergency department and primary care same-day visits

T2 - a natural experiment

AU - Pacheco, Jorge

AU - Cuadrado, Cristóbal

AU - Martínez-Gutiérrez, María Soledad

N1 - © The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: [email protected].

PY - 2019/4/2

Y1 - 2019/4/2

N2 - The aim of this study is to evaluate the impact of urgent care centres' (UCCs) implementation on emergency department (ED) and same-day visits in primary care in a Chilean public healthcare network. Quasi-experimental design study assessing changes in patient visits after UCC implementation in a local health district. Ten family health centres (FHC), nine UCCs and three EDs in the Talcahuano Health District, Chile. A total of 1 603 055 same-day visits to FHC, 1 528 319 visits to UCCs and 1 727 429 visits to EDs, monthly grouped, from 2008 to 2014. Data were obtained from the Monthly Statistical Register Database. We used quasi-experimental methods to evaluate the impact of UCC implementation on ED visits and same-day visits to FHC. We used a difference-in-difference analysis with seasonal adjustments to control potential confounders. We used a triple difference model to test for potential short-term effects. We used as an intervention a group of FHCs and EDs that implemented UCCs from 2008 to 2014 and, as a comparison group, the FHCs and EDs that implemented UCCs before that period. We observed a 5.70% (95% CI: -11.05 to -0.35) decrease in the same-day visits rate to FHCs and a 2.69% (95% CI: -3.96 to -1.43) reduction in ED visits after UCC implementation. The negative trend in same-day visits was more pronounced in children and adolescents (-14.18%; 95% CI: -20.10 to -8.25). The negative trend in ED visits was more pronounced in adult (-4.15%; 95% CI: -5.46 to -2.83) and elderly population (-2.24%; 95% CI: -4.00 to -0.48). We also confirmed that our results are not driven by transient short-term effects after the intervention. UCC implementation reduced ED visits. However, they also reduced same-day visits to primary care centres. This could have a negative impact on the quality of primary care provided.

AB - The aim of this study is to evaluate the impact of urgent care centres' (UCCs) implementation on emergency department (ED) and same-day visits in primary care in a Chilean public healthcare network. Quasi-experimental design study assessing changes in patient visits after UCC implementation in a local health district. Ten family health centres (FHC), nine UCCs and three EDs in the Talcahuano Health District, Chile. A total of 1 603 055 same-day visits to FHC, 1 528 319 visits to UCCs and 1 727 429 visits to EDs, monthly grouped, from 2008 to 2014. Data were obtained from the Monthly Statistical Register Database. We used quasi-experimental methods to evaluate the impact of UCC implementation on ED visits and same-day visits to FHC. We used a difference-in-difference analysis with seasonal adjustments to control potential confounders. We used a triple difference model to test for potential short-term effects. We used as an intervention a group of FHCs and EDs that implemented UCCs from 2008 to 2014 and, as a comparison group, the FHCs and EDs that implemented UCCs before that period. We observed a 5.70% (95% CI: -11.05 to -0.35) decrease in the same-day visits rate to FHCs and a 2.69% (95% CI: -3.96 to -1.43) reduction in ED visits after UCC implementation. The negative trend in same-day visits was more pronounced in children and adolescents (-14.18%; 95% CI: -20.10 to -8.25). The negative trend in ED visits was more pronounced in adult (-4.15%; 95% CI: -5.46 to -2.83) and elderly population (-2.24%; 95% CI: -4.00 to -0.48). We also confirmed that our results are not driven by transient short-term effects after the intervention. UCC implementation reduced ED visits. However, they also reduced same-day visits to primary care centres. This could have a negative impact on the quality of primary care provided.

KW - Adolescent

KW - Adult

KW - Aged

KW - Ambulatory Care Facilities/statistics & numerical data

KW - Child

KW - Chile

KW - Emergency Service, Hospital/statistics & numerical data

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Primary Health Care/statistics & numerical data

U2 - 10.1093/heapol/czz023

DO - 10.1093/heapol/czz023

M3 - Article

C2 - 30938409

SN - 0268-1080

VL - 34

SP - 170

EP - 177

JO - Health Policy and Planning

JF - Health Policy and Planning

IS - 3

ER -