[Impact in Asturias of primary care emergencies on hospital emergencies for the 1994-2001 period. A time series cointegration analysis]. / Impacto en asturias de las urgencias de atención primaria sobre las hospitalarias. Un análisis de cointegración de series temporales.

BACKGROUND: Greater accessibility to the primary care continuing care points (CCP's) could reduce the visits to the Hospital Emergency Services (HES's). This study analyses whether Primary Care can replace and Hospital Services in emergencies. METHODS: All of the emergency visits (n=6.454.034) made to the HES's and Primary Care CCP's in Asturias and of each one of the healthcare districts within the 1994-2001 period were calculated. The time series were constructed with monthly frequencies for Asturias and each one of the districts, a cointegration analysis having been made to assess whether the two series are inter-replaceable. RESULTS: A mean annual increase of the total number of emergencies in Asturias of 6.2% (CCP: 7,8%; HES: 5.1%) was found, with different growth among the healthcare districts. In the time series cointegration analysis, no replaceability was found between the primary care and hospital emergencies for Asturias and for the healthcare districts, except for the healthcare district of Oviedo, where a 10% growth rate in primary would lower hospital emergencies by 2.7%. CONCLUSIONS: The greater accessibility to the Primary Care CCP's increases the use thereof without reducing the visits to the HES's. Therefore, the increase in Primary Cart resources does not seem to be an effective alternative for reducing the visits to the HES's.

Impacto en Asturias de las urgencias de atención primaria sobre las hospitalarias: un análisis de cointegración de series temporales / Impact in Asturias of primary care emergencies on hospital emergencies for the 1994-2001 period. A time series cointegration analysis

Fundamento: La mayor accesibilidad a los puntos de atención continuada (PAC) de la atención primaria podría disminuir las visitas en los Servicios de Urgencias Hospitalarias (SUH). En este estudio se analiza si existe sustituibilidad entre las urgencias de Atención Primaria y Hospitalaria. Métodos: Se analiza la totalidad de las visitas urgentes (n=6.454.034) realizadas en los SUH de los hospitales y PAC de Atención Primaria de Asturias y de cada una de las áreas sanitarias entre 1994 y 2001. Se construyeron las series temporales con frecuencias mensuales para Asturias y cada una de las áreas y se realizó un análisis de cointegración para evaluar si existe sustituibilidad entre ambas series. Resultados: Se observó un incremento medio anual de las urgencias totales en Asturias del 6,2% (PAC: 7,8%; SUH: 5,1%), con diferente crecimiento entre las áreas sanitarias. En el análisis de cointegración de las series temporales no se detectó sustituibilidad entre las urgencias de atención primaria y hospitalaria para Asturias y para las áreas sanitarias, salvo en el área sanitaria de Oviedo, donde una tasa de crecimiento del 10% en primaria reduciría un 2,7% las urgencias hospitalarias. Conclusiones: La mayor accesibilidad a los PAC de Atención Primaria incrementa su utilización sin reducir las visitas en los SUH. En consecuencia, el incremento de recursos en Atención Primaria no parece constituir una alternativa eficaz para disminuir las visitas en los SUH

Background: Greater accessibility to the primary care continuing care points (CCP’s) could reduce the visits to the Hospital Emergency Services (HES’s). This study analyses whether Primary Care can replace and Hospital Services in emergencies. Methods: All of the emergency visits (n=6.454.034) made to the HES’s and Primary Care CCP’s in Asturias and of each one of the healthcare districts within the 1994-2001 period were calculated. The time series were constructed with monthly frequencies for Asturias and each one of the districts, a cointegration analysis having been made to assess whether the two series are inter-replaceable. Results: A mean annual increase of the total number of emergencies in Asturias of 6.2% (CCP: 7,8%; HES: 5.1%) was found, with different growth among the healthcare districts. In the time series cointegration analysis, no replaceability was found between the primary care and hospital emergencies for Asturias and for the healthcare districts, except for the healthcare district of Oviedo, where a 10% growth rate in primary would lower hospital emergencies by 2.7%. Conclusions: The greater accessibility to the Primary Care CCP’s increases the use thereof without reducing the visits to the HES’s. Therefore, the increase in Primary Care resources does not seem to be an effective alternative for reducing the visits to the HES’s

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

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.