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Observational Study
. 2018 Aug 28;18(1):663.
doi: 10.1186/s12913-018-3475-1.

24-hour access outpatient clinic for patients with exacerbation of chronic disease: a before-after cohort study of differences in acute healthcare utilisation

Anders Damgaard Møller  1 , David Høyrup Christiansen  2   3 , Cathrine Bell  4 , Ulrich Fredberg  4 , Peter Vedsted  4   5
Affiliations
Observational Study

24-hour access outpatient clinic for patients with exacerbation of chronic disease: a before-after cohort study of differences in acute healthcare utilisation

Anders Damgaard Møller et al. BMC Health Serv Res. .

Abstract

Background: Chronic diseases are becoming more common due to an increasing ageing population. Patients with chronic conditions managed in outpatient clinics account for a large share of healthcare costs. We developed a 24-h access outpatient clinic offering 24-h telephone support and triaged access to the hospital for patients with acute exacerbation of four selected chronic diseases. The aim of this study was to conduct a 1-year before-after study of the acute healthcare utilisation in patients offered the 24-h access outpatient clinic intervention.

Methods: The study was conducted as an observational register-based cohort study. Data from the patient administrative register and the Danish National Health Service Register were extracted 12 months before and 12 months after implementation of the 24-h access intervention. Patients with chronic obstructive pulmonary disease, chronic liver disease, inflammatory bowel disease and heart failure managed in hospital outpatient clinics were enrolled in the study. Differences in healthcare utilisation were analysed for all patients, including the subgroup of high-risk patients with at least one acute admission in the year before enrolment.

Results: Length-of-stay remained unchanged for all diagnostic groups, except for patients with heart failure in whom a statistically significant reduction was observed. Statistically significant reductions of length of stay and acute admissions were observed in all high-risk groups, except for patients with chronic liver disease. A statistically significant reduction in the number of contacts to out-of-hours primary care was seen in patients with chronic obstructive pulmonary disease, whereas the level remained unchanged in the other diagnostic groups. Similar patterns were also seen in high-risk patients.

Conclusions: The 24-h access outpatient clinic did not increase the use of acute healthcare services inpatients with chronic disease. Significant reductions in hospital utilisation were seen in high-risk patients. These preliminary results should be interpreted with caution due to the observational before-after design of the study.

Keywords: Ambulatory care; Before-after study; Chronic disease; Delivery of healthcare; Hotlines; Integrated healthcare systems.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Danish Data Protection Agency (file no: 2705). According to Danish law, register-based studies do not require approval by committees on biomedical research ethics, or informed consent. This was confirmed to apply for the present study by the Committee on Health Research Ethics in the Central Denmark Region (file no: 1–10–72-168-17).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Patient flow for patients with acute exacerbation enrolled in the 24-h outpatient clinic. GP; general practitioner
Fig. 2
Fig. 2
Healthcare utilisation 12 months before-after enrolment in the 24-h outpatient clinic – all patients. COPD; chronic obstructive pulmonary disease. IBD; inflammatory bowel disease. * p- value < .05. ** p- value < .01
Fig. 3
Fig. 3
Healthcare utilisation 12 months before-after enrolment in the 24-h outpatient clinic – high-risk patients. COPD; chronic obstructive pulmonary disease. IBD; inflammatory bowel disease. ** p- value < .01
See this image and copyright information in PMC

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