Redesigning After-Hours Primary Care
Authors: David Margolius, Thomas Bodenheimer
Journal: Annals of Internal Medicine (2011)

Editorials19 July 2011Redesigning After-Hours Primary CareDavid Margolius, MD and Thomas Bodenheimer, MDDavid Margolius, MDFrom University of California, San Francisco, San Francisco, CA 94110. and Thomas Bodenheimer, MDFrom University of California, San Francisco, San Francisco, CA 94110.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-155-2-201107190-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The article in this issue by Giesen and colleagues (1) on after-hours care in the Netherlands could not be more timely. Rising health care costs, particularly for Medicare and Medicaid, are devastating the U.S. budget. After-hours primary care, by reducing avoidable and expensive emergency department (ED) visits, could become a promising cost-containment strategy.The Netherlands has implemented a system of after-hours care in which cooperatives, encompassing 40 to 250 primary care physicians (PCPs), make available telephone triage nurses with physician backup to care for patients during evenings and weekends. Nurses, responding to urgent patient requests, follow triage protocols and offer ...References1. Giesen P, Smits M, Huibers L, Grol R, Wensing M. Quality of after-hours primary care in the Netherlands: a narrative review. Ann Intern Med. 2011;155:102-7. LinkGoogle Scholar2. Schoen C, Osborn R, Doty MM, Squires D, Peugh J, Applebaum S. A survey of primary care physicians in eleven countries, 2009: perspectives on care, costs, and experiences. Health Aff (Millwood). 2009;28:w1171-83. [PMID: 19884491] CrossrefMedlineGoogle Scholar3. Hildebrandt DE, Westfall JM, Smith PC. After-hours telephone triage affects patient safety. J Fam Pract. 2003;52:222-7. [PMID: 12620177] MedlineGoogle Scholar4. Tang N, Stein J, Hsia RY, Maselli JH, Gonzales R. Trends and characteristics of US emergency department visits, 1997-2007. JAMA. 2010;304:664-70. [PMID: 20699458] CrossrefMedlineGoogle Scholar5. Overuse of emergency departments among insured Californians. Oakland, CA: California Healthcare Foundation; October 2006. Google Scholar6. Mehrotra A, Keehl-Markowitz L, Ayanian JZ. Implementing open-access scheduling of visits in primary care practices: a cautionary tale. Ann Intern Med. 2008;148:915-22. [PMID: 18559842] LinkGoogle Scholar7. Lowe RA, Localio AR, Schwarz DF, Williams S, Tuton LW, Maroney S, et al. Association between primary care practice characteristics and emergency department use in a medicaid managed care organization. Med Care. 2005;43:792-800. [PMID: 16034293] CrossrefMedlineGoogle Scholar8. Bogdan GM, Green JL, Swanson D, Gabow P, Dart RC. Evaluating patient compliance with nurse advice line recommendations and the impact on healthcare costs. Am J Manag Care. 2004;10:534-42. [PMID: 15352529] MedlineGoogle Scholar9. Piehl MD, Clemens CJ, Joines JD. "Narrowing the gap": decreasing emergency department use by children enrolled in the Medicaid program by improving access to primary care. Arch Pediatr Adolesc Med. 2000;154:791-5. [PMID: 10922275] CrossrefMedlineGoogle Scholar10. Franco SM, Mitchell CK, Buzon RM. Primary care physician access and gatekeeping: a key to reducing emergency department use. Clin Pediatr (Phila). 1997;36:63-8. [PMID: 9118591] CrossrefMedlineGoogle Scholar11. Schoen C, Osborn R, Huynh PT, Doty M, Peugh J, Zapert K. On the front lines of care: primary care doctors' office systems, experiences, and views in seven countries. Health Aff (Millwood). 2006;25:w555-71. [PMID: 17102164] CrossrefMedlineGoogle Scholar12. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27:759-69. [PMID: 18474969] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: David Margolius, MD; Thomas Bodenheimer, MDAffiliations: From University of California, San Francisco, San Francisco, CA 94110.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1112.Corresponding Author: David Margolius, MD, San Francisco General Hospital, 1001 Potrero Avenue, Building 80-83, San Francisco, CA 94110; e-mail, [email protected]com.Current Author Addresses: Dr. Margolius: San Francisco General Hospital, 1001 Potrero Avenue, Building 80-83, San Francisco, CA 94110.Dr. Bodenheimer: San Francisco General Hospital, 995 Potrero Avenue, Building 80, Ward 83, San Francisco, CA 94110. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoQuality of After-Hours Primary Care in the Netherlands: A Narrative Review Paul Giesen , Marleen Smits , Linda Huibers , Richard Grol , and Michel Wensing Redesigning After-Hours Primary Care Michael E. Miller Redesigning After-Hours Primary Care Azeem Majeed Redesigning After-Hours Primary Care David Margolius and Thomas Bodenheimer Metrics Cited byComparison between primary care service delivery in Malaysia and other participating countries of the QUALICOPC project: a cross-sectional studyAmbulatory Care–Sensitive Conditions Associated With Potentially Avoidable Hospital AdmissionsPotentially avoidable hospitalisations of German nursing home patients? 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Asplin, MD, MPHThe Impact on Emergency Department Utilization and Patient Flows after Integrating with a General Practitioner Cooperative: An Observational StudyAfter-Hours Access To Primary Care Practices Linked With Lower Emergency Department Use And Less Unmet Medical NeedAfter-Hours Care and its Coordination with Primary Care in the U.S.Redesigning After-Hours Primary CareMichael E. Miller, MDRedesigning After-Hours Primary CareAzeem Majeed, MDThe American Healthcare SystemConvenient Care Trends 19 July 2011Volume 155, Issue 2Page: 131-132KeywordsEmergency departmentHealth careNursesPatientsPrevention, policy, and public healthPrimary carePrimary care physiciansSafetySafety studiesTriage ePublished: 19 July 2011 Issue Published: 19 July 2011 Copyright & PermissionsCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...