![]() Aimed at reducing ED overuse –leading to needless expense, crowding and lower access to those in real need– wide-ranging organizational changes have been implemented in Italy mostly involving primary care, including initiatives designed to promote the extension of opening hours and out-of-hours care by GP groups, establish Walk-in-Clinics that are primary-care-based emergency services inside or near to hospitals or, more recently to a greater extent, establish Community Health Centres (CHCs, Case della Salute in Italian) able to provide a wider range of acute and chronic medical care and, by strengthening regional healthcare, useful in increasing the appropriateness of ED visits. In recent decades there has been increasing interest in improving primary care organization with specific emphasis, among other objectives, on reducing the number of ED referrals for avoidable non-severe conditions. In addition, our findings suggest that where CHCs and WiCs coexist in the same area, it may be advisable to implement strategies that bring WiC activities into step with CHC-based general primary care reforms to avoid duplication. Our results confirm the hypothesis that expanding access to primary care settings diminishes inappropriate ED use. As regards Aim 2, in the city of Parma patients whose GP belongs to the CHC are less likely to visit the WiC on a workday, with no significant change during the weekend when CHCs are closed, questioning the need to maintain them both in the same area when the CHC model is fully implemented. ResultsĪs regards Aim 1, we show that CHCs reduce the probability of inappropriate patient access to emergency care. In this case we try to assess whether, and to what extent, the progressive development of the CHCs in the city of Parma has been affecting the dynamics of WiC access (Aim 2). Second, we focus our attention on Walk-in-Clinics, investigating the long-established WiC in the city of Parma that currently coexists with three CHCs recently established in the same catchment area. First we test the existence of a “CHC effect”, choosing five urban cities with different degree of development of the CHC model and assessing whether, all else being equal, patients treated by GPs who have their premises inside the CHC show a lower need to seek inappropriate care (Aim 1). Estimating panel count data models for the period 2015–2018, we pursue two goals. We focus on the Italian Emilia-Romagna Region that has made huge investments in CHC development, whilst failing to proceed at a uniform rate from area to area. Community care has recently been restructured with the development of Community Health Centres (CHCs), forcing a general rethink on the survival of previous organizational solutions adopted to reduce inappropriate ED access, for example Walk-in-Clinics (WiCs).
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