Top

BMC Emergency Medicine

Published in:

01-12-2021 | Triage | Research

Pre- and post-home visit behaviors after using after-hours house call (AHHC) medical services: a questionnaire-based survey in Tokyo, Japan

Authors: Ryota Inokuchi, Kojiro Morita, Xueying Jin, Masatoshi Ishikawa, Nanako Tamiya

Published in: BMC Emergency Medicine | Issue 1/2021

Abstract

Background

After-hours house call (AHHC) medical services have been implemented in Japan to reduce ambulance use, as well as overcrowding at the emergency department (ED). Examining the pre-and post-home visit behaviors of those using AHHC medical services will provide insights into the usefulness of these services and help develop strategies to reduce ED visits and ambulance use further.

Methods

This questionnaire-based study used data from anonymized medical records and internet-based questionnaires completed by patients who used AHHC medical services in Tokyo, Japan, between January 1 and December 31, 2019. The questionnaire comprised two questions: (1) What action would the patient have taken in the absence of AHHC services and (2) what action was taken within 3 days following the use of the AHHC services. In addition, following home consultations, AHHC doctors classified the patient’s illness severity as mild (treatable with over-the-counter medications), moderate (requires hospital or clinic visit), or severe (requires ambulance transportation).

Results

Of the 15,787 patients who used AHHC medical services during the study period, 2128 completed the questionnaire (13.5% response rate). Individuals aged ≤15 years and 16–64 years were the most common users of AHHC services (≤15 years, 71.4%; 16–64 years, 26.8%). Before using the AHHC service, 46.4% of the total respondents reported that they would have visited an ED had AHHC services not been available (≤15 years, 47.8%; 16–64 years, 42.8%; ≥65 years, 43.6%). The proportion of patients originally planning to call an ambulance was higher among those in the older age groups (≤15 years, 1.1%; 16–64 years, 6.0%; ≥65 years, 20.5%). After using the AHHC services, most patients (68.1%) did not visit a hospital within 3 days; however, the proportion of patients who visited an ED and called an ambulance within 3 days increased with the severity of illness.

Conclusions

Increasing AHHC medical services awareness among older adults and patients assessed as having severe illnesses regularly availing of AHHC services may help reduce ED visits and ambulance use.

Available only for authorised users

Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: a systematic review of causes, consequences and solutions. PLoS One. 2018;13(8):e0203316. https://doi.org/10.1371/journal.pone.0203316.CrossRefPubMedPubMedCentral

Yarmohammadian MH, Rezaei F, Haghshenas A, Tavakoli N. Overcrowding in emergency departments: a review of strategies to decrease future challenges. J Res Med Sci. 2017;22(1):23. https://doi.org/10.4103/1735-1995.200277.CrossRefPubMedPubMedCentral

Foster H, Moffat KR, Burns N, Gannon M, Macdonald S, O'Donnell CA. What do we know about demand, use and outcomes in primary care out-of-hours services? A systematic scoping review of international literature. BMJ Open. 2020;10(1):e033481. https://doi.org/10.1136/bmjopen-2019-033481.CrossRefPubMedPubMedCentral

Theocharis G, Barbas SG, Spiropoulos T, Stamouli PE, Perdikis DN, Falagas ME. Patient house calls in Attica and Thessaloniki, Greece (2005-2015): a model for out-of-hospital multispecialty emergency medicine. BMC Health Serv Res. 2018;18(1):304. https://doi.org/10.1186/s12913-018-3111-0.CrossRefPubMedPubMedCentral

Theocharis G, Kechagias KS, Oikonomou M, Chorepsima S, Rodis D, Salpigktis I, et al. A model for out-of-hospital multispecialty emergency medicine: accomplishments and challenges. Health Serv Insights. 2018;11:1178632918805996. https://doi.org/10.1177/1178632918805996.CrossRefPubMedPubMedCentral

Colombo A, Bert F, Camussi E, Gualano MR, Arensi D, Castaldo D, et al. Analysis of users and reasons for use of a physician-on-call service in an Italian local health unit. Fam Pract. 2016;33(6):684–9. https://doi.org/10.1093/fampra/cmw089.CrossRefPubMed

Allen AR, Turbitt E, Freed GL. Use of home visiting GP services by paediatric patients presenting at emergency departments. Aust Fam Physician. 2016;45(4):230–5.PubMed

Ruiz S, Snyder LP, Rotondo C, Cross-Barnet C, Colligan EM, Giuriceo K. Innovative home visit models associated with reductions in costs, hospitalizations, and emergency department use. Health Aff (Millwood). 2017;36(3):425–32. https://doi.org/10.1377/hlthaff.2016.1305.CrossRef

Sakurai A, Morimura N, Takeda M, Miura K, Kiyotake N, Ishihara T, et al. A retrospective quality assessment of the 7119 call triage system in Tokyo - telephone triage for non-ambulance cases. J Telemed Telecare. 2014;20(5):233–8. https://doi.org/10.1177/1357633X14536347.CrossRefPubMed

10.

Yamashita H, Koga H, Yano K, Taki K, Shima H. The problem and the strategy of increased emergency transport in the geriatric emergency medicine: Especially about charged ambulance. J Jpn Soc Emer Med. 2016;19(1):1–6.

11.

Fire and Disaster Management Agency. Current status of emergency and rescue services. https://www.fdma.go.jp/pressrelease/houdou/items/c941509de3f85432709ea0d63bf23744756cd4a5.pdf. (Accessed 22 Jan 2021).

12.

Fire and Disaster Management Agency. White Paper on Fire Service. https://www.fdma.go.jp/publication/hakusho/r1/items/r1_all.pdf. (Accessed 22 Jan 2021).

13.

Tamiya N, Noguchi H, Nishi A, Reich MR, Ikegami N, Hashimoto H, et al. Population ageing and wellbeing: lessons from Japan's long-term care insurance policy. Lancet. 2011;378(9797):1183–92. https://doi.org/10.1016/S0140-6736(11)61176-8.CrossRefPubMed

14.

Yoshida S, Matsumoto M, Kashima S, Koike S, Tazuma S, Maeda T. Geographical distribution of family physicians in Japan: a nationwide cross-sectional study. BMC Fam Pract. 2019;20(1):147. https://doi.org/10.1186/s12875-019-1040-6.CrossRefPubMedPubMedCentral

15.

Sakamoto H, Rahman M, Nomura S, Okamoto E, Koike S, Yasunaga H, et al. Japan Health System Review. Vol. 8 No. 1. New Delhi: World Health Organization, Regional Office for South-East Asia; 2018.

16.

Inokuchi R, Sato H, Nakajima S, Shinohara K, Nakamura K, Gunshin M, et al. Development of information systems and clinical decision support systems for emergency departments: a long road ahead for Japan. Emerg Med J. 2013;30(11):914–7. https://doi.org/10.1136/emermed-2012-201869.CrossRefPubMed

17.

Inokuchi R, Sato H, Nakamura K, Aoki Y, Shinohara K, Gunshin M, et al. Motivations and barriers to implementing electronic health records and ED information systems in Japan. Am J Emerg Med. 2014;32(7):725–30. https://doi.org/10.1016/j.ajem.2014.03.035.CrossRefPubMed

18.

Kawakami C, Ohshige K, Kubota K, Tochikubo O. Influence of socioeconomic factors on medically unnecessary ambulance calls. BMC Health Serv Res. 2007;7(1):120. https://doi.org/10.1186/1472-6963-7-120.CrossRefPubMedPubMedCentral

19.

Otsuki H, Murakami Y, Fujino K, Matsumura K, Eguchi Y. Analysis of seasonal differences in emergency department attendance in Shiga prefecture, Japan between 2007 and 2010. Acute Med Surg. 2016;3(2):74–80. https://doi.org/10.1002/ams2.140.CrossRefPubMed

20.

Inokuchi R, Morita K, Iwagami M, Watanabe T, Ishikawa M, Tamiya N. Changes in the proportion and severity of patients with fever or common cold symptoms utilizing an after-hours house call medical service during the COVID-19 pandemic in Tokyo, Japan: a retrospective cohort study. BMC Emerg Med. 2021;21(1):64. https://doi.org/10.1186/s12873-021-00458-8.CrossRefPubMedPubMedCentral

21.

Morita K, Inokuchi R, Jin X, Ishikawa M, Tamiya N. Patients' impressions of after-hours house-call services during the COVID-19 pandemic in Japan: a questionnaire-based observational study. BMC Fam Pract. 2021;22(1):184. https://doi.org/10.1186/s12875-021-01534-5.CrossRefPubMedPubMedCentral

22.

Moll van Charante EP, van Steenwijk-Opdam PC, Bindels PJ. Out-of-hours demand for GP care and emergency services: patients' choices and referrals by general practitioners and ambulance services. BMC Fam Pract. 2007;8(1):46. https://doi.org/10.1186/1471-2296-8-46.CrossRefPubMedPubMedCentral

23.

Ifediora CO, Rogers GD. Continuity of care in after-hours house call medical services: an exploration of follow-up patterns in an Australian context. J Eval Clin Pract. 2018;24(3):514–20. https://doi.org/10.1111/jep.12902.CrossRefPubMed

24.

Buckley DJ, Curtis PW, McGirr JG. The effect of a general practice after-hours clinic on emergency department presentations: a regression time series analysis. Med J Aust. 2010;192(8):448–51. https://doi.org/10.5694/j.1326-5377.2010.tb03583.x.CrossRefPubMed

25.

Jones D, Carroll L, Frank L. After-hours care in suburban Canada: influencing emergency department utilization. J Prim Care Community Health. 2011;2(4):250–4. https://doi.org/10.1177/2150131911408431.CrossRefPubMed

26.

O'Malley AS. After-hours access to primary care practices linked with lower emergency department use and less unmet medical need. Health Aff (Millwood). 2013;32(1):175–83. https://doi.org/10.1377/hlthaff.2012.0494.CrossRef

27.

van Uden CJ, Crebolder HF. Does setting up out of hours primary care cooperatives outside a hospital reduce demand for emergency care? Emerg Med J. 2004;21(6):722–3. https://doi.org/10.1136/emj.2004.016071.CrossRefPubMedPubMedCentral

28.

Yazaki H, Nishiura H. Ambulance Transport of Patients with Mild Conditions in Hokkaido, Japan. Int J Environ Res Public Health. 2020;17(3):919. https://doi.org/10.3390/ijerph17030919.CrossRefPubMedCentral

29.

Platts-Mills TF, Leacock B, Cabañas JG, Shofer FS, McLean SA. Emergency medical services use by the elderly: analysis of a statewide database. Prehosp Emerg Care. 2010;14(3):329–33. https://doi.org/10.3109/10903127.2010.481759.CrossRefPubMed

30.

Tokuda Y, Abe T, Ishimatsu S, Hinohara S. Ambulance transport of the oldest old in Tokyo: a population-based study. J Epidemiol. 2010;20(6):468–72. https://doi.org/10.2188/jea.JE20090210.CrossRefPubMedPubMedCentral

31.

Squire BT, Tamayo A, Tamayo-Sarver JH. At-risk populations and the critically ill rely disproportionately on ambulance transport to emergency departments. Ann Emerg Med. 2010;56(4):341–7. https://doi.org/10.1016/j.annemergmed.2010.04.014.CrossRefPubMed

32.

Meurice L, Chapon T, Chemin F, Gourinchas L, Sauvagnac S, Uijttewaal S, et al. General practitioner house call network (SOS Médecins): an essential tool for syndromic surveillance - Bordeaux, France. Prehosp Disaster Med. 2020;35(3):326–30. https://doi.org/10.1017/S1049023X20000308.CrossRefPubMed

33.

Fortin Ensign S, Baca-Motes K, Steinhubl SR, Topol EJ. Characteristics of the modern-day physician house call. Medicine (Baltimore). 2019;98(8):e14671. https://doi.org/10.1097/MD.0000000000014671.CrossRef

34.

Kelly SJ, Piercy H, Ibbotson R, Fowler Davis SV. Who attends out-of-hours general practice appointments? Analysis of a patient cohort accessing new out-of-hours units. BMJ Open. 2018;8(6):e020308. https://doi.org/10.1136/bmjopen-2017-020308.CrossRefPubMedPubMedCentral

35.

Ministry of Internal Affairs and Communications. White paper. The information and communications in Japan. [http://www.soumu.go.jp/johotsusintokei/whitepaper/ja/h26/pdf/n5300000.pdf] (Accessed on 22 Jan 2021).

36.

Dejean D, Giacomini M, Welsford M, Schwartz L, Decicca P. Inappropriate ambulance use: a qualitative study of Paramedics' views. Health Policy. 2016;11(3):67–79. https://doi.org/10.12927/hcpol.2016.24535.CrossRef

Title: Pre- and post-home visit behaviors after using after-hours house call (AHHC) medical services: a questionnaire-based survey in Tokyo, Japan
Authors: Ryota Inokuchi
Kojiro Morita
Xueying Jin
Masatoshi Ishikawa
Nanako Tamiya
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Triage
Care
Published in: BMC Emergency Medicine / Issue 1/2021
Electronic ISSN: 1471-227X
DOI: https://doi.org/10.1186/s12873-021-00545-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pre- and post-home visit behaviors after using after-hours house call (AHHC) medical services: a questionnaire-based survey in Tokyo, Japan

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Adherence to the ABCDE approach in relation to the method of instruction: a randomized controlled simulation study

Barriers and facilitators to cardiopulmonary resuscitation within pre-hospital emergency medical services: a qualitative study

Impact of the COVID-19 pandemic on incidence and severity of acute appendicitis: a comparison between 2019 and 2020

Prehospital time and mortality in polytrauma patients: a retrospective analysis

Exploring overcrowding trends in an inner city emergence department in the UK before and during COVID-19 epidemic

Comparison of the novel VieScope with conventional and video laryngoscope in a difficult airway scenario – a randomized, controlled simulation trial