Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2017 Nov 28;25(1):116.
doi: 10.1186/s13049-017-0460-3.

The Effect on the Patient Flow in Local Health Care Services After Closing a Suburban Primary Care Emergency Department: A Controlled Longitudinal Follow-Up Study

Affiliations
Free PMC article
Observational Study

The Effect on the Patient Flow in Local Health Care Services After Closing a Suburban Primary Care Emergency Department: A Controlled Longitudinal Follow-Up Study

Katri Mustonen et al. Scand J Trauma Resusc Emerg Med. .
Free PMC article

Abstract

Background: It has not been studied what happens to patient flow to EDs and other parts of local health care system if distances to ED services are manipulated as a part of health policy in urban areas.

Methods: The present work was an observational and quasi-experimental study with a control and it was based on before-after comparisons. The impact of terminating a geographically distant suburban primary care ED on patient flow to doctors in local public primary care EDs, office-hour primary care, secondary care EDs and in private primary care was studied. The effect of this intervention was compared with a primary care system where no similar intervention was performed. The number of monthly visits to doctors in different departments of health care was scored as the main measure of the study in each department studied (e.g. in primary care EDs, secondary care ED, office-hour public primary care and private primary care). Monthly mortality rates were also recorded.

Results: Increasing the distance to ED services by terminating a peripheral ED did not cause an increase in the use of local office-hour services in those areas whose local ED was terminated, although use of ED services decreased by 25% in these areas (P < 0.001). The total use of primary care doctor services rather decreased - if anything - after this intervention while use of doctor services in secondary care ED remained unaffected. Doctor visits to the complementary private primary care increased but this was probably not associated with the intervention because a simultaneous increase in this parameter was observed in the control. There was no increased mortality in any age groups.

Conclusion: Manipulating distances to ED services can be used to direct patient flows to different parts of the health care system. The correlation between distance to ED and the tendency to use ED by inhabitants is negative. If secondary care ED was available there were no life-threatening side-effects at the level of general public health when a minor ED was closed in a primary care ED system.

Keywords: Distance; Emergency department; Primary care; Suburban.

Conflict of interest statement

Ethics approval and consent to participate

According to the Finnish laws of register research, no ethical approval was required because this study was made directly by computer from the patient register in such a form that the scientists were not able to identify the patients (https://rekisteritutkimus.wordpress.com/luvat-ja-tietosuoja/). The registry keeper (the health authorities of Helsinki University Central Hospital [HUCH], Espoo and Vantaa and Social Insurance Institution of Finland [SII]) permitted access to the data and granted permission (23.8.2013) to carry out the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests. The data of the manuscript is available upon request from the corresponding author.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The map of Vantaa, its districts and EDs
Fig. 2
Fig. 2
a) Number of monthly recorded patient visits to GPs as a function of distance to the ED in “Area X” before the closure of this ED. Mean is shown with bars and the size of 95% CI with a bracket. b) Number of monthly recorded patient visits to GPs as a function of distance to the ED in “Control area A” before the closure of the ED in “Area X”. c) Number of monthly recorded patient visits to GPs as a function of distance to the ED in “Control area A” after the closure of the ED in “Area X”
Fig. 3
Fig. 3
a) Total number of monthly recorded patient visits to GPs of Vantaa public primary care. The figure shows the original data in the form of an XmR-chart: mean ± 3 δ, e.g. UCL and LCL, are presented. b) Total number of monthly recorded patient visits to GPs of the control public primary care, Espoo. c) Number of monthly recorded office-hour patient visits to GPs of Vantaa primary care. d) Number of monthly recorded office-hour patient visits to GPs of the control primary care, Espoo
Fig. 4
Fig. 4
a) Number of monthly recorded patient visits to GPs of Vantaa primary care EDs. The figure shows the original data in the form of an XmR-chart: mean ± 3 δ, e.g. UCL and LCL, are presented. b) Number of monthly recorded patient visits to GPs of control primary care EDs in Espoo. c) Number of monthly recorded patient visits of inhabitants of Vantaa in private primary care doctors. d) Number of monthly recorded patient visits of inhabitants of Espoo, the control, in private primary care doctors
Fig. 5
Fig. 5
a) Number of monthly recorded patient visits from “Area X” to GPs of ED in “Control area A”. The figure shows the original data in the form of an XmR-chart: mean ± 3 δ, e.g. UCL and LCL, are presented. b) Number of monthly recorded patient visits from “Area Y” to GPs of ED in “Control area A”. c) Number of monthly recorded patient visits to the GPs of the office-hour primary care in different areas. Mean is shown with bars and the size of 95% CI with a bracket
Fig. 6
Fig. 6
The monthly mortality in different age groups (a 0-19 years, b 20-64 years, and c 65+ years). The figures show the original data in the form of an XmR-chart: mean ± 3 δ, e.g. UCL and LCL, are presented

Similar articles

See all similar articles

Cited by 2 articles

References

    1. Ingram DR, Clarke DR, Murdie RA. Distance and the decision to visit an emergency department. Soc Sci Med. 1978;12:55–62. doi: 10.1016/0160-8002(78)90007-2. - DOI - PubMed
    1. Roghmann KJ, Zastowny TR. Proximity as a factor in the selection of health care providers: emergency room visits compared to obstetric admissions and abortions. Soc Sci Med. 1979;13:61–69. - PubMed
    1. Magnusson G. The role of proximity in the use of hospital emergency departments. Sociol Health Illn. 1980;2:202–214. doi: 10.1111/1467-9566.ep10487794. - DOI - PubMed
    1. Bowling A, Isaacs D, Armston J, Roberts JE, Elliott EJ. Patient use of a paediatric hospital casualty department in the east end of London. Fam Pract. 1987;4:85–90. doi: 10.1093/fampra/4.2.85. - DOI - PubMed
    1. Hull SA, Jones IR, Moser K. Factors influencing the attendance rate at accident and emergency Departments in East London: the contributions of practice organization, population characteristics and distance. J Health Serv Res Policy. 1997;2:6–13. - PubMed

Publication types

MeSH terms

LinkOut - more resources

Feedback