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Extended access to primary care linked to less ED visits

By offering evening and weekend services, primary care practices were able to reduce local ED visits for minor problems by 26.4%, according to data published in PLOS Medicine.

The researchers, based in Manchester, England, added that the results of their study have informed the decision of the National Health Service (NHS) to extend primary care access across Greater Manchester from 2016.

“Financial pressures on the NHS in England have led to a policy focus on improving access to primary care, both to deliver a more convenient service for patients and, in doing so, to relieve pressures on hospital care,” William Whittaker, PhD, MSc, of the Manchester Centre for Health Economics, at the University of Manchester, and colleagues wrote. “To this end, the UK government has invested ₤150 million (U.S. $229/€207 million) since 2013 in a number of regional initiatives to extend access to primary care across England, as part of a long-term plan to extend 7-day working across the entire NHS.”

To determine the effect of extended primary care access on ED services, the researchers conducted a difference-in-differences analysis using hospital administrative data from 2011 to 2014. Throughout 2014, 56 primary care practices in Greater Manchester, serving 346,024 patients, offered 7-day access, including weekend and evening openings, for both urgent and routine appointments. The control group, which comprised 469 primary care practices serving 2,596,330 patients, provided routine access.

The researchers used propensity score matching techniques to match practices without extended access to practices with extended access. Differences in the change in minor patient-initiated ED visits per 1,000 residents were compared between the two groups.

According to the researchers, participants in practices with extended access demonstrated a 26.4% relative decrease in patient-initiated ED visits for minor problems, compared with the control group (95% CI, –38.6% to –14.2%; absolute difference = –10,933 per year, 95% CI, –15,995 to –5,866). In addition, those visits were associated with a 26.6% (95% CI, –39.2% to –14.1%) relative reduction in costs, compared with the control group (absolute difference = –₤767,976, –₤1,130,767 to –₤405,184). There was an insignificant, 3.1% reduction in total ED visits.

“The international evidence on the effects of improved access to primary care on [ED] use is inconclusive, has rarely analyzed cost data and has lacked robust comparators,” Whittaker and colleagues wrote. “Our study uses more robust methods and suggests that extending opening hours in primary care may be a useful addition to policies aiming to reduce pressures on hospital services, potentially reducing patient-initiated use of the [ED] for minor problems — but at a significant cost.” – by Jason Laday

Disclosure: Whittaker reports grant funding for other work from the Department of Health Policy Research Programme. See the full study for additional researchers’ disclosures.