Urgent care centres reduce emergency department and primary care same-day visits: a natural experiment

摘要

The aim of this study is to evaluate the impact of urgent care centres' (UCCs) implementation on emergency department (ED) and same-day visits in primary care in a Chilean public healthcare network. Quasi-experimental design study assessing changes in patient visits after UCC implementation in a local health district. Ten family health centres (FHC), nine UCCs and three EDs in the Talcahuano Health District, Chile. A total of 1603055 same-day visits to FHC, 1528319 visits to UCCs and 1727429 visits to EDs, monthly grouped, from 2008 to 2014. Data were obtained from the Monthly Statistical Register Database. We used quasi-experimental methods to evaluate the impact of UCC implementation on ED visits and same-day visits to FHC. We used a difference-in-difference analysis with seasonal adjustments to control potential confounders. We used a triple difference model to test for potential short-term effects. We used as an intervention a group of FHCs and EDs that implemented UCCs from 2008 to 2014 and, as a comparison group, the FHCs and EDs that implemented UCCs before that period. We observed a 5.70% (95% CI: -11.05 to -0.35) decrease in the same-day visits rate to FHCs and a 2.69% (95% CI: -3.96 to -1.43) reduction in ED visits after UCC implementation. The negative trend in same-day visits was more pronounced in children and adolescents (-14.18%; 95% CI: -20.10 to -8.25). The negative trend in ED visits was more pronounced in adult (-4.15%; 95% CI: -5.46 to -2.83) and elderly population (-2.24%; 95% CI: -4.00 to -0.48). We also confirmed that our results are not driven by transient short-term effects after the intervention. UCC implementation reduced ED visits. However, they also reduced same-day visits to primary care centres. This could have a negative impact on the quality of primary care provided.