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The European Journal of Public Health Advance Access published online on June 3, 2006
The European Journal of Public Health, doi:10.1093/eurpub/ckl085
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© The Author 2006. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Received November 10, 2005
Accepted April 11, 2006

Article

Does better access to primary care reduce utilization of hospital accident and emergency departments? A time-series analysis

D. Oterino de la Fuente 1, J. F. Baños Pino 2, V. Fernández Blanco 2, and A. Rodríguez Álvarez 2 *

1 Department of Preventive Medicine and Public Health, University of Oviedo, Oviedo, Spain; Fundación Instituto de Investigación en Servicios de Salud, Spain
2 Department of Economics, University of Oviedo, Oviedo, Spain

* To whom correspondence should be addressed.
A. Rodríguez Álvarez, E-mail: ana{at}uniovi.es


  Abstract

Background: Availability of primary care emergency facilities has been improved to help curb heavy growth in the use of Accident and Emergency Departments (A&EDs). The aim of this paper is to analyse the relationship between time series for visits to hospital A&EDs and primary care centres. Methods: Using a co-integration time series we analyse the visits to the emergency services of the county hospital and seven healthcare primary centres in the healthcare district of Mieres, Asturias, España, during the period 1992-1999. The main outcome measured is the relationship between the time series for emergency visits to the primary care centres and the hospital A&ED, for groups aged 0-14 years, over 14 years and the total. Results: A total of 506 158 visits to the emergency services of the primary care centres (62.4%) and hospital A&ED (37.6%) have been studied. Emergency visits rose by 40.9% during the period studied (50.3% in primary care centres and 26.5% in the hospital). The gross rise in visits was higher for adults (51.2%) than for 0-14 year olds (6.6%). The co-integration time-series analysis showed that in both age groups and in the total, there was a significant and positive relationship between the primary care and hospital series, indicating that the use of both services had grown simultaneously. The use of the hospital services did not decrease as a result of the increase in primary care services. Conclusions: The rise in use of primary care emergency services did not reduce use of the hospital A&ED.

Keywords: Accident and Emergency Departments; emergency visits; primary care; time series.
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