title: Predictors of emergency department referral in patients using out-of-hours primary care services.
abstract: BACKGROUND
  Out of hours (OOH) doctors could manage many cases limiting the inappropriate accesses to ED. However the possible determinants of referral to ED by OOH doctors are poorly studied. We aimed to characterize patients referred from the OOH to ED service in order to explore the gate-keeping role of OOH service for hospital emergency care and to facilitate future research in improving its cost-effectiveness.
  
  
  METHODS
  A retrospective study was made through data collection of 5217 contacts in a local OOH service in the North-East of Italy (from 10/01/2012 to 03/31/2013).
  
  
  RESULTS
  Only 8.7% (=454 people) of the total contacts were referred to ED. In the multivariate analysis, the significant predictors of being sent to ED were: age; residence in nursing home (odds ratios (OR)=2.00, 95%CI: 1.30-3.10); being visited by a OOH physician (OR=2.64, 95%CI: 2.09-3.34). Taking infections as reference, cardiovascular diseases (OR=18.31, 95%CI: 12.01-27.90), traumas (OR=8.75, 95%CI: 5.36-14.26) and gastrointestinal conditions (OR=7.69, 95%CI: 4.70-11.91) increased the probability to be referred to ED.
  
  
  CONCLUSIONS
  OOH service addresses several common medical conditions in community-dwelling and in nursing home context, supporting its filtering function for the ED access. The main reasons of ED access could be a crucial aspect in general population education in order to avoid the overcrowding of the ED.
authors: Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy.
authors: Maria Paola
authors: MP
authors: Scapinello
authors: Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy; Scuola di Formazione Specifica in Medicina Generale, Regione Veneto, Venice, Italy.
authors: Andrea
authors: A
authors: Posocco
authors: Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy.
authors: Irene
authors: I
authors: De Ronch
authors: Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy.
authors: Francesco
authors: F
authors: Castrogiovanni
authors: Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy.
authors: Gianluca
authors: G
authors: Lollo
authors: Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy.
authors: Guglielmo
authors: G
authors: Sergi
authors: Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy.
authors: Iginio
authors: I
authors: Tomaselli
authors: Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy.
authors: Loris
authors: L
authors: Tonon
authors: Department of Neurosciences, University of Padova, Padova, Italy; Unità Locale Socio Sanitaria 17, Monselice, Italy; Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy.
authors: Marco
authors: M
authors: Solmi
authors: Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy.
authors: Stefano
authors: S
authors: Traversa
authors: Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy.
authors: Vincenzo
authors: V
authors: Zambianco
authors: Unità Locale Socio Sanitaria 7, Pieve di Soligo (TV), Continuità Assistenziale Vittorio Veneto (TV), Italy; University of Padova, Department of Medicine, Geriatrics Section, Italy; Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy. Electronic address: ilmannato@gmail.com.
authors: Nicola
authors: N
authors: Veronese
mesh_terms: D039602:After-Hours Care / Q000706:statistics & numerical data*; D000367:Age Factors; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D011320:Primary Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies
keywords: Emergency department; Gate-keeping; Out-of-hours primary care