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Publication type: Article in scientific journal
Type of review: Peer review (publication)
Title: Walk-ins seeking treatment at an emergency department or general practitioner out-of-hours service : a cross-sectional comparison
Authors: Chmiel, Corinne
Huber, Carola A.
Rosemann, Thomas
Zoller, Marco
Eichler, Klaus
Sidler, Patrik
Senn, Oliver
DOI: 10.21256/zhaw-4055
Published in: BMC Health Services Research
Volume(Issue): 11
Issue: 94
Issue Date: 2011
Publisher / Ed. Institution: BioMed Central
ISSN: 1472-6963
Language: English
Subjects: Primary care; Versorgungsforschung; Emergency care
Subject (DDC): 362: Health and social services
Abstract: Background: Emergency Departments (ED) in Switzerland are faced with increasing numbers of patients seeking non-urgent treatment. The high rate of walks-ins with conditions that may be treated in primary care has led to suggestions that those patients would best cared for in a community setting rather than in a hospital. Efficient reorganization of emergency care tailored to patients needs requires information on the patient populations using the various emergency services currently available. The aim of this study is to evaluate the differences between the characteristics of walk-in patients seeking treatment at an ED and those of patients who use traditional out-of-hours GP (General Practitioner) services provided by a GP-Cooperative (GP-C). Methods: In 2007 and 2009 data was collected covering all consecutive patient-doctor encounters at the ED of a hospital and all those occurring as a result of contacting a GP-C over two evaluation periods of one month each. Comparison was made between a GP-C and the ED of the Waid City Hospital in Zurich. Patient characteristics, time and source of referral, diagnostic interventions and mode of discharge were evaluated. Medical problems were classified according to the International Classification of Primary Care (ICPC-2). Patient characteristics were compared using non-parametric tests and multiple logistic regression analysis was applied to investigate independent determinants for contacting a GP-C or an ED. Results: Overall a total of 2974 patient encounters were recorded. 1901 encounters were walk-ins and underwent further analysis (ED 1133, GP-C 768). Patients consulting the GP-C were significantly older (58.9 vs. 43.8 years), more often female (63.5 vs. 46.9%) and presented with non-injury related medical problems (93 vs. 55.6%) in comparison with patients at the ED. Independent determining factors for ED consultation were injury, male gender and younger age. Walk-in distribution in both settings was equal over a period of 24 hours and most common during daytime hours (65%). Outpatient care was predominant in both settings but significantly more so at the GP-C (79.9 vs. 85.7%). Conclusions: We observed substantial differences between the two emergency settings in a non gate-keeping health care system. Knowledge of the distribution of diagnoses, their therapy, of diagnostic measures and of the factors which determine the patients choice of the ED or the GP-C is essential for the efficient allocation of resources and the reduction of costs.
Fulltext version: Published version
License (according to publishing contract): CC BY 2.0: Attribution 2.0 Generic
Departement: School of Management and Law
Organisational Unit: Winterthur Institute of Health Economics (WIG)
Appears in Collections:Publikationen School of Management and Law

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