Research ArticleOriginal Research

Effect of Access to After-Hours Primary Care on the Association Between Home Nursing Visits and Same-Day Emergency Department Use

Aaron Jones, Susan E. Bronskill, Connie Schumacher, Hsien Seow, David Feeny and Andrew P. Costa
The Annals of Family Medicine September 2020, 18 (5) 406-412; DOI: https://doi.org/10.1370/afm.2571

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Association between home nursing and emergency department visits, overall and within each category of access to after-hours care.

    ED = emergency department; Q1 = Quartile 1; Q2 = Quartile 2; Q3 = Quartile 3; Q4 = Quartile 4.

  • Figure 2
    Figure 2

    Association between home nursing and emergency department visits, overall and within each category of access to after-hours care, adjusted for other potential effect modifiers.

    ED = emergency department; Q1 = Quartile 1; Q2 = Quartile 2; Q3 = Quartile 3; Q4 = Quartile 4.

    Note: Adjusted for potential modifying effects of primary care practice type, rurality, functional impairment, and presence of a live-in caregiver.

Tables

  • Table 1

    Characteristics of Home Care Patients

    Patient CharacteristicsAll Patients (n = 11,840), No. (%)History of After-Hours Care Use (n = 2,550), No. (%)No History of After-Hours Care Use (n = 9,290), No. (%)
    Demographics
    Age, median (IQR), y77 (65-86)77 (66-87)76 (64-85)
    Sex, female6,048 (51)1,356 (53)4,692 (51)
    Living alone4,432 (37)886 (35)3,546 (38)
    Health
    ADL impairmenta
     Independent/Supervision6,345 (54)1,208 (47)5,137 (55)
     Limited/Extensive3,624 (31)774 (30)2,850 (31)
     Maximal/Dependent1,871 (16)568 (22)1,303 (14)
    Cognitive impairmentb
     Intact/Borderline intact5,438 (46)1,117 (44)4,321 (47)
     Mild/Moderate5,687 (48)1,213 (48)4,474 (48)
     Severe715 (6)220 (9)495 (5)
    Frailty indexc
     Robust (0-0.19)2,420 (20)450 (18)1,970 (21)
     Pre-frail (0.2-0.29)3,106 (26)593 (23)2,513 (27)
     Frail (≥0.3)6,314 (53)1,507 (59)4,807 (52)
    Depressive symptoms6,615 (56)1,477 (58)5,138 (55)
    Aggressive behaviors1,144 (10)276 (11)868 (9)
    Fall in last 90 days4,823 (41)1,008 (40)3,815 (41)
    Bladder incontinence4,147 (35)1,009 (40)3,138 (34)
    Current medications (≥5)10,399 (88)2,265 (89)8,134 (88)
    Dementia1,832 (15)445 (17)1,387 (15)
    Clinical need indicators
    Wound care5,338 (45)1,177 (46)4,161 (45)
    Intravenous medications1,116 (9)206 (8)910 (10)
    Indwelling urinary catheter2,029 (17)422 (17)1,607 (17)
    Congestive heart failure2,262 (19)498 (20)1,764 (19)
    Chronic obstructive pulmonary disease3,096 (26)652 (26)2,444 (26)

    • ADL = activities of daily living; IQR = interquartile range.

    • ↵a ADL Hierarchy Scale: Includes personal hygiene, locomotion, eating, and toileting.

    • ↵b Cognitive performance scale

    • ↵c Scores on the frailty index range from 0 to 1, where 0 represents no health deficits and 1 represents all possible health deficits.

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