ED use drops when medical practices extend office hours

More than 40% of patients say their physicians offer care on nights and weekends, keeping some out of the emergency department, a new study says.

By — Posted Dec. 31, 2012

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When primary care physicians keep their doors open after usual business hours, patients are able to contact those doctors for care and advice instead of going to an emergency department, a new report concludes.

In surveying more than 9,500 people with steady sources of care, the Center for Studying Health System Change focused its results on 1,470 individuals who had tried to contact their primary care practices after normal business hours in the past year. The study, published online in Health Affairs on Dec. 12, found that nearly 21% had difficulties reaching their physicians after hours.

These people were much more likely to come to the emergency department or not seek treatment for needed care, as opposed to individuals who had fewer problems seeking medical help after hours. Patients in practices with after-hours care reported the fewest difficulties in seeking care beyond normal business hours, along with children, people in good health and those with private insurance.

Those who reported more difficulty accessing after-hours care had higher rates of emergency department use — 37.7% vs. 30.4% for those with less difficulty — and higher rates of unmet medical needs, at 13.7% compared with 6.1% for those with more access, the study said.

The findings suggest that rates of ED use and unmet medical problems could drop if more primary care practices kept their doors open longer or stayed accessible either by phone or email, said Ann O’Malley, MD, MPH, an HSC senior fellow and author of the report. More than 40% of the respondents with regular sources of care said their physicians offered extended hours on nights or weekends.

James King, MD, a family physician in Selmer, Tenn., said his practice is able to offer extended hours during the week and on Saturdays because it divides the after-hours care among four physicians and three nurse practitioners.

“We stagger the hours so that everyone’s quality of life is maintained” as much as possible, something that’s more difficult to do in smaller practices, he said.

He believes the extended hours play a role in fewer ED visits, because it assists patients who can’t get off work during the day to see a doctor, or who “come home from work at 5 p.m. and find a child with a temperature of 102 degrees.”

Seeing one’s physician during extended hours also holds down medical costs, Dr. King said. “You go into the emergency room, they have to work up everything for your abdominal pain if that’s what you’re in for: the CT scans, lab work, urinalysis.” In an office where staff already know the patient and know that the abdominal pain is an ongoing problem, ancillary tests aren’t always needed, he said.

Andrew Sama, MD, president of the American College of Emergency Physicians, said extended hours at primary care offices in all likelihood would reduce some ED visits, although he said he didn’t know exact numbers of patients affected or dollar amounts saved. He’s the senior vice president of emergency services at North Shore-Long Island Jewish Health System in Manhasset, N.Y.

It does help to have access to past medical histories, and to speak directly with the patient’s primary care doctor when he or she comes to the ED, Dr. Sama said, but that’s not always possible. There are times when an ED contacts a patient’s primary care practice and a covering physician answers the phone who “knows nothing about the patient, nor do they have access to their records,” he said.

Dr. King suggested that practices partner with urgent care facilities in the community that supply after-hours care if the doctors can’t offer these services themselves. “Your patients know to go there, and then the urgent care center knows to get information back to their primary care physician when they’re seen” by their regular office, he said.

This can keep patients out of the ED and avoid duplicate tests.

But depending on the nature of the complaint, a trip to the emergency department is sometimes warranted, especially when it involves severe and sudden complaints, Dr. Sama said. Even if that patient doesn’t have an acute abdominal emergency, it’s important that he or she is seen right away to rule out this condition, he added.

More than 20% of patients have trouble reaching their physicians after office hours.

Nearly half of family physicians offer extended office hours.

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Family physicians step up after-hours care

In a survey of 655 members, the American Academy of Family Physicians found that nearly half had expanded office hours to patients, including early morning and evening appointments. “We believe that having appropriate access to care is part of the patient-centered medical home,” said AAFP President Jeffrey Cain, MD. “Better access improves quality and lowers costs.” According to the AAFP survey:

  • More than 73% offered same-day scheduling
  • Nearly 49% had extended office hours
  • Nearly 32% offered weekend appointments

Source: 2010 Practice Profile Survey, American Academy of Family Physicians

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External links

“After-Hours Access To Primary Care Practices Linked With Lower Emergency Department Use And Less Unmet Medical Need,” Health Affairs, published online Dec. 12 (link)

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