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Measuring the impact of an acute visiting scheme on emergency department attendances – a pre-post cohort design
BACKGROUND: Emergency department (ED) attendances are contributing to rising costs of the National Health Service (NHS) in England. Critically assessing the impact of new services to reduce emergency department use can be difficult as new services may create additional access points, unlocking laten...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164303/ https://www.ncbi.nlm.nih.gov/pubmed/34049540 http://dx.doi.org/10.1186/s12913-021-06557-3 |
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author | Kaehne, Axel Keating, Paula |
author_facet | Kaehne, Axel Keating, Paula |
author_sort | Kaehne, Axel |
collection | PubMed |
description | BACKGROUND: Emergency department (ED) attendances are contributing to rising costs of the National Health Service (NHS) in England. Critically assessing the impact of new services to reduce emergency department use can be difficult as new services may create additional access points, unlocking latent demand. The study evaluated an Acute Visiting Scheme (AVS) in a primary care context. We asked if AVS reduces overall ED demand and whether or not it changed utilisation patterns for frequent attenders. METHOD: The study used a pre post single cohort design. The impact of AVS on all-cause ED attendances was hypothesised as a substitution effect, where AVS duty doctor visits would replace emergency department visits. Primary outcome was frequency of ED attendances. End points were reduction of frequency of service use and increase of intervals between attendances by frequent attenders. RESULTS: ED attendances for AVS users rose by 47.6%. If AVS use was included, there was a more than fourfold increase of total service utilisation, amounting to 438.3%. It shows that AVS unlocked significant latent demand. However, there was some reduction in the frequency of ED attendances for some patients and an increase in time intervals between ED attendances for others. CONCLUSION: The study demonstrates that careful analysis of patient utilisation can detect a differential impact of AVS on the use of ED. As the new service created additional access points for patients and hence introduces an element of choice, the new service is likely to unlock latent demand. This study illustrates that AVS may be most useful if targeted at specific patient groups who are most likely to benefit from the new service. |
format | Online Article Text |
id | pubmed-8164303 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-81643032021-06-01 Measuring the impact of an acute visiting scheme on emergency department attendances – a pre-post cohort design Kaehne, Axel Keating, Paula BMC Health Serv Res Research Article BACKGROUND: Emergency department (ED) attendances are contributing to rising costs of the National Health Service (NHS) in England. Critically assessing the impact of new services to reduce emergency department use can be difficult as new services may create additional access points, unlocking latent demand. The study evaluated an Acute Visiting Scheme (AVS) in a primary care context. We asked if AVS reduces overall ED demand and whether or not it changed utilisation patterns for frequent attenders. METHOD: The study used a pre post single cohort design. The impact of AVS on all-cause ED attendances was hypothesised as a substitution effect, where AVS duty doctor visits would replace emergency department visits. Primary outcome was frequency of ED attendances. End points were reduction of frequency of service use and increase of intervals between attendances by frequent attenders. RESULTS: ED attendances for AVS users rose by 47.6%. If AVS use was included, there was a more than fourfold increase of total service utilisation, amounting to 438.3%. It shows that AVS unlocked significant latent demand. However, there was some reduction in the frequency of ED attendances for some patients and an increase in time intervals between ED attendances for others. CONCLUSION: The study demonstrates that careful analysis of patient utilisation can detect a differential impact of AVS on the use of ED. As the new service created additional access points for patients and hence introduces an element of choice, the new service is likely to unlock latent demand. This study illustrates that AVS may be most useful if targeted at specific patient groups who are most likely to benefit from the new service. BioMed Central 2021-05-28 /pmc/articles/PMC8164303/ /pubmed/34049540 http://dx.doi.org/10.1186/s12913-021-06557-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Kaehne, Axel Keating, Paula Measuring the impact of an acute visiting scheme on emergency department attendances – a pre-post cohort design |
title | Measuring the impact of an acute visiting scheme on emergency department attendances – a pre-post cohort design |
title_full | Measuring the impact of an acute visiting scheme on emergency department attendances – a pre-post cohort design |
title_fullStr | Measuring the impact of an acute visiting scheme on emergency department attendances – a pre-post cohort design |
title_full_unstemmed | Measuring the impact of an acute visiting scheme on emergency department attendances – a pre-post cohort design |
title_short | Measuring the impact of an acute visiting scheme on emergency department attendances – a pre-post cohort design |
title_sort | measuring the impact of an acute visiting scheme on emergency department attendances – a pre-post cohort design |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164303/ https://www.ncbi.nlm.nih.gov/pubmed/34049540 http://dx.doi.org/10.1186/s12913-021-06557-3 |
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