Reader Health Services Research, Medical School, Edge Hill University, Ormskirk, L39 4QP, UK.
Head of Women's and Children's Health Care, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK.
BMC Health Serv Res. 2021 May 28;21(1):521. doi: 10.1186/s12913-021-06557-3.
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.
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.
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.
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.
在英国，急诊科（ED）就诊量的增加导致国民保健服务（NHS）成本不断上升。由于新服务可能会开辟额外的准入途径，从而释放潜在需求，因此，要准确评估新服务减少急诊科就诊量的影响可能颇具难度。本研究评估了初级保健背景下的急性就诊计划（AVS）。我们想知道 AVS 是否会降低整体 ED 需求，以及它是否改变了高频就诊者的就诊模式。
本研究采用了前后单队列设计。假设 AVS 对所有原因 ED 就诊的影响是一种替代效应，即 AVS 值班医生的就诊将取代急诊科就诊。主要结局是 ED 就诊的频率。终点是通过频繁就诊者减少服务使用的频率和增加就诊间隔。
AVS 用户的 ED 就诊次数增加了 47.6%。如果包括 AVS 的使用，总服务利用率增加了四倍多，达到 438.3%。这表明 AVS 释放了显著的潜在需求。然而，一些患者的 ED 就诊频率有所下降，另一些患者的就诊间隔有所增加。
该研究表明，仔细分析患者的使用情况，可以发现 AVS 对 ED 使用的影响存在差异。由于新服务为患者创造了额外的准入途径，从而引入了选择因素，因此新服务可能会释放潜在需求。本研究表明，如果 AVS 针对最有可能从新服务中受益的特定患者群体，那么它可能会更有用。
