Primary care interventions that avert emergency department presentations: a rapid review
Emergency Department (ED) service use in Australia has increased in recent years; however, approximately 30% of ED presentations could be managed within primary health care. A recent systematic review conducted in the UK identified interventions that could potentially reduce inappropriate ED attendances, but many of these showed negligible effect. The aim of this review was to update the evidence relating to primary care interventions with outcome interests that specifically reduced ED visits, increased patient satisfaction, increased cost-effectiveness, and/or increased primary care utilisation.
We conducted an electronic search of PubMed, the NHS Economic Evaluation Database, the Health Technology Assessment Database, and the Cochrane Collaboration database for studies published between 1 January 2011 and 12 March 2015. We included studies that considered a primary care service intervention or those that addressed one or more outcomes of interest. Studies were assessed using the Scottish Intercollegiate Guidelines Network (SIGN) checklists for quality assessment.
Of the 1156 articles identified, 17 were included in the review. We found that Patient-Centred Medical Homes (PCMHs) significantly reduced ED use, improved primary care utilisation, and decreased overall health related costs. In contrast, community-based programs and free clinics had minimal effects on reducing ED use, but decreased healthcare costs and increased patient satisfaction.
Over the last five years, the literature points to PCMHs as the most effective intervention at significantly reducing ED use, improving primary care utilisation and reducing overall health-related costs. However, the studies supporting this claim were mainly targeting specific cohorts (ie, disadvantaged and vulnerable groups) in the US and may not be transferable to health systems in other countries. Therefore, any new strategies for reducing inappropriate ED attendances must be tailored to local health systems to ensure that outcomes are meaningful and relevant.