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. Jan-Dec 2019;10:2150132719865151.
doi: 10.1177/2150132719865151.

A Primary Care Emergency Service Reduction Did Not Increase Office-Hour Service Use: A Longitudinal Follow-up Study

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A Primary Care Emergency Service Reduction Did Not Increase Office-Hour Service Use: A Longitudinal Follow-up Study

Mika Lehto et al. J Prim Care Community Health. .
Free PMC article


This study, conducted in a Finnish city, examined whether decreasing emergency department (ED) services in an overcrowded primary care ED and corresponding direction to office-hour primary care would guide patients to office-hour visits to general practitioners (GP). This was an observational retrospective study based on a before-and-after design carried out by gradually decreasing ED services in primary care. The interventions were (a) application of ABCDE-triage combined with public guidance on the proper use of EDs, (b) cessation of a minor supplementary ED, and finally (c) application of "reverse triage" with enhanced direction of the public to office-hour services from the remaining ED. The numbers of visits to office-hour primary care GPs in a month were recorded before applying the interventions fully (preintervention period) and in the postintervention period. The putative effect of the interventions on the development rate of mortality in different age groups was also studied as a measure of safety. The total number of monthly visits to office-hour GPs decreased slowly over the whole study period without difference in this rate between pre- and postintervention periods. The numbers of office-hour GP visits per 1000 inhabitants decreased similarly. The rate of monthly visits to office-hour GP/per GP did not change in the preintervention period but decreased in the postintervention period. There was no increase in the mortality in any of the studied age groups (0-19, 20-64, 65+ years) after application of the ED interventions. There is no guarantee that decreasing activity in a primary care ED and consecutive enhanced redirecting of patients to the office-hour primary care systems would shift patients to office-hour GPs. On the other hand, this decrease in the ED activity does not seem to increase mortality either.

Keywords: community health centers; emergency department; mortality; practice management; primary care.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


Figure 1.
Figure 1.
(a) Number of monthly visits to the doctors of the primary care emergency departments (EDs) in each year of the follow-up. Median (dot), 25% (lower bracket) and 75% (upper bracket) ranges are shown. (b) Number of monthly visits to the office-hour general practitioners (GPs).
Figure 2.
Figure 2.
(a) Number of monthly visits to the office-hour general practitioners (GPs) adjusted to the population. (b) Number of monthly visits to the office-hour GPs adjusted to the number of GPs.
Figure 3.
Figure 3.
Numbers of deaths/1000 person in different age-groups: (a) 0-19 years, (b) 20-64 years, and (c) 65+ years.

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