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Take two aspirin and call me in the morning

Practices with after-hours access can prevent patients from seeking emergency care and meet patients’ needs.

"Enteric coated aspirin 2" by Sage Ross (via Flickr / Creative Commons License) With various care models being evaluated to improve access to health care while simultaneously decreasing the cost of care, a recent article examines how after-hours access to a primary care practices improves continuity of care, decreases health care costs, and eliminates unnecessary visits to the emergency department.

Medical problems that arise after hours often force patients to seek care in local emergency rooms or urgent care facilities.  This introduces additional providers who are not knowledgeable of the patient’s medical background; these providers often do not have access to the patient’s prior medical records.  This leads to fragmented care that could be potentially dangerous for the patient. It often results in duplicate testing.  Telephone access and expanded clinic hours on weekends and holidays should increase overall access to care.

This article describes the demand for and availability of after-hours care among people with a usual source of primary care.  It examines the relationship of the ease of accessing care on outcome variables including hospitalizations, emergency department visits, and patients’ reports of unmet medical need.

Participants were selected based on the characteristics of their primary care office, choosing a subset of patients with access to after-hours care and those who reported an attempt to contact their primary care provider after-hours via phone, e-mail, electronic patient portal, or in person (n=1,470).

Patients who reported “poor” health status, those without insurance (41.6% vs. 16.2%, p<0.01) or covered by Medicaid/CHIP (30.6% vs. 16.2%, p<0.01), and Hispanics (34.7% vs. 16.4%, p<0.05) reported significantly more difficulty obtaining after-hours care as compared to better health statuses, private insurance, and White patients, respectively.  Those patients with difficulty contacting a usual source of after-hours care had a higher rate of emergency department use (37.7% vs. 30.4%, p<0.05) and unmet medical needs (13.7% vs. 6.1%, p<0.01).

Commentary

This study provides a foundation to evaluate improved access to care with a regular primary physician as an ideal model to improve the cost and quality of health care.  It provides a solid baseline investigation into improving continuity of care among the insured with their own primary care physicians and provides a process to help eliminate non-urgent emergency department  visits. This could prove cost saving.

Although this model for after-hours primary care would serve as an efficient way to improve access among those currently with a primary care provider, it fails to address the reimbursement of providers assigned to after-hours duty.  It also fails to indicate which services would be available after-hours as it would probably be impractical to run a full-service care center simply for the chance of emergency calls from a practices’ patient panel.

Critical to the understanding of after-hours care includes the imaging modalities, laboratory testing, and access to patient medical records available to the on duty clinician.  More research is needed, but this study serves as a valuable baseline. Until comprehensive after-hours care from primary care physicians is a reality, emergency departments and retail clinics remain options for patients.

O’Malley, AS. Health Affairs. 2012; web first.

by

Ellana Stinson, MD 

About Ellana Stinson, MD

Ellana Stinson, MD is an emergency medicine physician practicing in Boston, MA. She is currently a candidate for a Master of Public Health in Policy and Management from the Harvard School of Public Health. Dr. Stinson received a Bachelor's of Science degree from Spelman College and graduated with Alpha Omega Alpha honors from Meharry Medical College. Her interests lie in improving health disparities for vulnerable populations with a focus on payment reform and in ensuring the sustainability of safety net facilities. She began contributing to Policy Prescriptions® in 2012. Contact: Facebook | Twitter | More Posts

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