A systematic review of the impact of afterhours care models on emergency departments, ambulance and general practice services

Summary 

Introduction

The aim of the systematic review was to examine (i) the impact of afterhours primary care models on ED, ambulance services and or general practitioners and (ii) the effectiveness of these services (afterhours) on nurse practitioners and/or the medical doctors delivery of care.

Method

Articles were assessed using the Critical Appraisal Skills Programme (CASP) making sense of evidence tools and covered the period from 1970 to 2011. The data sources searched were: Cumulative Index to Nursing and Allied Health literature, Medline, EMBASE, The Cochrane Database of Systematic Reviews, PubMed, Science Direct and Proquest.

Results

A total of 2268 were retrieved and 419 studies were identified. Eighty-seven studies were found to be relevant. Nine countries are represented in the data. There were few relevant Randomised Controlled Trials (n=5). The evidence was largely based on quasi experimental (time series), before and after or comparative studies. Studies were usually set within a single hospital or community setting with heterogeneous samples, short sample periods, and or measured a single outcome such as patient satisfaction.

Conclusions

Six models were identified from the review which highlighted evidence that afterhour care models can reduce GP workload and to a lesser extent ED and ambulance services. Potentially these models could ease acute care work load, improve access across the vast geographical distances of Australia.

Keywords: Systematic review, Afterhours care, Workforce, Emergency, Health care reform, Service delivery