title: Complaints and Diagnoses of Emergency Department Patients in the Netherlands: A Comparative Study of Integrated Primary and Emergency Care.
abstract: OBJECTIVE
  In the Netherlands, an increasing number of emergency departments (EDs) and general practitioner cooperatives collaborate by creating one Emergency-Care-Access-Point (ECAP). This has resulted in fewer patients at ECAP EDs. The objective of this study was to explore differences in patient characteristics, presented complaints and ED discharge diagnoses between EDs with an ECAP and EDs without an ECAP.
  
  
  METHODS
  A retrospective observational study was performed with 1800 consecutive patient records sampled from six EDs spread over the Netherlands in 2013. We extracted data on time and date of presentation, sex, age, presenting complaint, discharge diagnosis, origin and follow up.
  
  
  RESULTS
  At ECAP EDs, the mean age was 47.8 years (95%CI 46.1-49.4) compared to 41.3 (95%CI 39.7-42.9). Compared to non-ECAP EDs, more patients were referred by medical professionals (74.7% versus 46.8%), more patients received hospital admission (45.2% versus 29.0%) and fewer patients received GP follow-up (4.1% versus 16.9%). There was no significant difference in presenting complaints between ECAP and non-ECAP EDs. Most prevalent complaints were trauma (25.7% versus 29.7%), abdominal pain (12.1% versus 10.9%) and general symptoms (7.8% versus 4.8%). The most prevalent ED diagnoses significantly differed with fractures and dislocations (10.8%), sprains and strains (10.4%) and respiratory infections (6.8%) at ECAP EDs versus fractures and dislocations (10.7%), wounds (9.3%) and sprains and strains (8.9%) at non-ECAP EDs.
  
  
  CONCLUSIONS
  Compared to non-ECAP EDs, patients at ECAP EDs were older, medical professionals referred more patients and more patients received a hospital admission. We found some small differences in discharge diagnoses between ECAP EDs compared to non-ECAP EDs, but no difference in presented complaints.
authors.affiliation: Emergency Department, Catharina Hospital, Eindhoven, the Netherlands; IQ Scientific Institute for Quality of Health Care, Radboud University, Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Wendy A M H
authors.initials: WA
authors.lastname: Thijssen
authors.forename: Elske
authors.initials: E
authors.lastname: van Mierlo
authors.affiliation: Emergency Department, Catharina Hospital, Eindhoven, the Netherlands.
authors.forename: Elske
authors.initials: E
authors.lastname: van Miero
authors.affiliation: Emergency Department, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.
authors.forename: Maartje
authors.initials: M
authors.lastname: Willekens
authors.affiliation: Emergency Department, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: Jasper
authors.initials: J
authors.lastname: Rebel
authors.affiliation: Emergency Department, Haga Hospital, The Hague, the Netherlands.
authors.forename: Maro H
authors.initials: MH
authors.lastname: Sandel
authors.affiliation: IQ Scientific Institute for Quality of Health Care, Radboud University, Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Giesen
authors.affiliation: IQ Scientific Institute for Quality of Health Care, Radboud University, Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055815:Young Adult