Primary-care clinic treatment improves patient follow up

Jan 14 2013

By medwireNews Reporters

Treating low-acuity emergency-department (ED) patients in a primary-care clinic results in better future primary care follow up, research shows.

More than half of patients treated in the primary-care clinic had at least one follow up visit in the year following the intervention compared with just one-third of patients treated in the ED.

"We believe the initial continuity of care shown in our study is a first step toward linkage with a usual source of primary care," report Stephen Wall (Bellevue Hospital Center, New York, USA) and colleagues in the Annals of Emergency Medicine.

The study was performed at a large urban hospital in New York that treats more than 100,000 patients in the ED annually. The hospital's primary-care clinic is in the same building complex and treats more than 500,000 outpatients each year.

Investigators enrolled 965 patients presenting to the ED with selected conditions that a layperson would be expected to identify as nonemergent. Of these patients, 191 were assigned to the ED urgent-care group and 662 to the primary-care clinic.

The conditions included symptoms consistent with a urinary tract infection, sore throat, medication refills, nontraumatic joint or back pain, and symptoms typical of a cold. In addition, patients requesting treatment for chronic illnesses, such as headache, diabetes, or hypertension, were also included.

In the intention-to-treat analysis, the primary-care-clinic patients were more likely to achieve successful primary care follow up than the ED patients.

The absolute adjusted risk difference for primary care follow up - defined as at least one visit to the primary-care clinic following the initial visit - was 9.3% in favor of the primary-care clinic intervention.

In a multivariable adjusted risk model, the primary-care-clinic patients were 72% more likely to attend follow up than were the ED-treated patients.

This translated into a number needed to treat of 11 patients in order to have at least one additional patient follow up with the primary-care clinic.

In patient surveys, completed by 71% of the study population, primary-care-clinic patients were significantly more likely to rate their care as "very good" compared with ED-treated patients.

The researchers note that approximately 30% of patients refused to be enrolled in the study, and therefore the results might not be generalizable to all ED patients. Furthermore, they were only able to track healthcare use at Bellevue Hospital, New York, and so it is possible that some patients received care elsewhere.

That said, just one-third of patients included in the study had a personal physician at baseline, note Wall and colleagues.

They conclude: "Given its position as the point of entry into the healthcare system for many underserved patients, the ED may be an ideal place for interventions to improve access to primary care."

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