After-hours primary care and non-urgent emergency department use by adult patients from St. John's, Newfoundland & Labrador

• Main Author: Siromani, Jerome D.
• Format: Thesis
• Language: English
• Published: Memorial University of Newfoundland 2023
• Subjects: Newfoundland
• Online Access: https://research.library.mun.ca/15896/; https://research.library.mun.ca/15896/1/thesis.pdf

Background: Wait times in Canadian Emergency Departments are among the highest in the industrialized world, and avoidable Emergency Department (ED) visits have been associated with greater costs. Primary Objective: Describe the relationship between after-hours care by Family Physicians (FPs) and low-acuity ED visits by adult patients from the St. John’s Metropolitan Area (SJMA), while controlling for non-modifiable patient characteristics. Methods: A retrospective cross-sectional observational study utilizing administrative data (2011-2015) was performed. Residents of the SJMA were assigned to their most frequent provider of primary care services according to Fee-For-Service (FFS) billings and patient records from university-affiliated Academic Family Physicians (AFPs). FPs practicing under the FFS model were categorized according to the percentage of their billings that included a supplementary after-hours fee code (i.e., <5%, 5-14.9%, 15-24.9%, and >25%), which served as a proxy for access to after-hours care. AFPs were in a distinct category because they practice in a unique model, which includes (a) 24/7 access to telephone triage, (b) follow-up that might include an after-hours visit, and (c) no FFS billings. Regression models included a categorical predictor variable, which comprised patients categorized via after-hours billings of FFS FPs, as well as patients of AFPs. To further clarify the relationship identified above, the relationship between after-hours billings and low-acuity ED visits was examined - with calendar date as the unit of analysis. Results: Differences in access to after-hours care among patients of FFS FPs were not associated with a difference in low-acuity ED visits, but patients of AFPs made significantly fewer low-acuity ED visits. With the reference category comprising patients of FFS FPs who had <5% of after-hours billings, the respective Rate Ratios (95% Confidence Intervals) were 0.99 (0.9-1.09) for the 5-14.9% category, 1.05 (0.88-1.27) for the 15-24.9% category, and ...