title: Interventions to reduce emergency department utilisation: A review of reviews.
abstract: OBJECTIVE
  To describe policy interventions that have the objective to reduce ED use and to estimate their effectiveness.
  
  
  METHODS
  Narrative review by searching three electronic databases for scientific literature review papers published between 2010 and October 2015. The quality of the included studies was assessed with AMSTAR, and a narrative synthesis of the retrieved papers was applied.
  
  
  RESULTS
  Twenty-three included publications described six types of interventions: (1) cost sharing; (2) strengthening primary care; (3) pre-hospital diversion (including telephone triage); (4) coordination; (5) education and self-management support; (6) barriers to access emergency departments. The high number of interventions, the divergent methods used to measure outcomes and the different populations complicate their evaluation. Although approximately two-thirds of the primary studies showed reductions in ED use for most interventions the evidence showed contradictory results.
  
  
  CONCLUSIONS
  Despite numerous publications, evidence about the effectiveness of interventions that aim to reduce ED use remains insufficient. Studies on more homogeneous patient groups with a clearly described intervention and control group are needed to determine for which specific target group what type of intervention is most successful and how the intervention should be designed. The effective use of ED services in general is a complex and multi-factorial problem that requires integrated interventions that will have to be adapted to the specific context of a country with a feedback system to monitor its (un-)intended consequences. Yet, the co-location of GP posts and emergency departments seems together with the introduction of telephone triage systems the preferred interventions to reduce inappropriate ED visits while case-management might reduce the number of ED attendances by frequent ED users.
authors.affiliation: Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium. Electronic address: Koen.vandenheede@kce.fgov.be.
authors.forename: Koen
authors.initials: K
authors.lastname: Van den Heede
authors.affiliation: Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium. Electronic address: Carine.vandevoorde@kce.fgov.be.
authors.forename: Carine
authors.initials: C
authors.lastname: Van de Voorde
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D006300:Health Services Misuse / Q000517:prevention & control*; D006302:Health Services Research; D006801:Humans; D011320:Primary Health Care / Q000706:statistics & numerical data
keywords: Emergency medical services; Health services research; Utilisation