How do interventions in primary care or in emergency departments impact less urgent patients' emergency care utilization? A systematic review
Abstract
BACKGROUND: Health care policy in Germany focuses on restructuring ambulatory emergency care services to serve patients more efficiently. Up to 60% of patients self-refer to emergency departments (EDs), although a relevant share could be treated in primary care. This systematic review aims to determine how interventions in primary care or in emergency departments impact emergency care utilization, especially by less urgent patients self-referring to EDs. METHODS: This systematic review was registered in PROSPERO in 2023. MEDLINE, the Cochrane Library, and Epistemonikos were last searched in April 2025. Reference- and cited-by-searches were conducted. RCTs or non-randomized studies with an intervention and a comparison group were included. Titles and abstracts were screened, and the quality of full texts was assessed by 2 independent reviewers. Quality assessment was conducted with the Cochrane Risk-of-Bias Tool for RCTs and with the ROBINS-I criteria for non-randomized studies. Data on study characteristics and results were extracted by one reviewer and checked by a second reviewer. The outcome of primary interest was the utilization of EDs or primary care services. RESULTS: Data was extracted for the following interventions: changes in the accessibility/availability of primary care physicians; new/alternative primary care services for emergency care; patient education about available emergency services; addition of primary care services to EDs; introduction of common access…
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