Abstract

Objectives: After-hours clinics (AHCs) have been identified as a means to improve primary care access. The study objective was to evaluate the impact of AHC intervention on avoided emergency department (ED) visits and cost savings.

Design: This study is an interrupted time series analysis of prospectively collected AHC patient survey data and AHC and ED visit census data.

Setting: The study settings were the WestView Primary Care Network (WPCN) of suburban family physician clinics and an associated ED in Alberta.

Intervention: An AHC intervention was initiated in 2005 and continued to the present.

Participants: Study participants were all patients who visited the AHC from inception to 2016–2017. Patients completed a survey indicating where they would alternatively have sought care had the AHC not been available.

Main outcome measures: Avoided ED visits were measured by patients' responses indicating that they would have gone to the ED had the AHC not been available. AHC visit costs were calculated from WPCN administrative records. The average cost of Canadian Triage and Acuity Scale (CTAS) 4 and 5 visits in Alberta that did not lead to admission was used to approximate cost savings by deferred ED visits.

Results: From inception to 2016–2017, a total of 108,616 AHC visits were made. AHC availability led to 40,046 avoided ED visits. Increasing numbers of patients reported attachment to a family physician over the study period. Concurrently with AHC implementation, the number of CTAS 4 and 5 visits that did not lead to admission at the local ED during times of AHC intake significantly declined. In Canadian dollars (2017 $ value), the AHC led to a net cost saving of $4.7 million and a net annual cost saving of $428,588 based on ED visits deferred from 2006–2007 to 2016–2017.

Conclusion: Our data suggest that AHCs may decrease avoidable, low-acuity ED visits and save healthcare system costs.