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Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

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1. By integrating Dutch primary care physician cooperatives with emergency departments, overall emergency department use has been reduced by 22%.

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2. Other recent developments to the Dutch system include access to electronic health records of daytime primary care practices and direct access to more diagnostic facilities.

Study Rundown:

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One of the major challenges in primary care is organizing accessible, high-quality, and affordable care after regular office hours, with the goal of minimizing unnecessary hospital visits. The primary care system in the Netherlands is strong and may serve as a good example for other countries, like the United States, that are looking to reframe their after-hours system. In 2011, the authors of this study published a narrative review of previously published Dutch studies on several aspects of after-hours care. Since important changes have been made over the past 5 years, the authors revisited and updated their previous review. This review has several limitations. For example, while the updated review assesses aspects like collaboration with emergency departments, it does not reevaluate the patient experience with the new developments made to the Dutch healthcare system. Additionally, for countries trying to use this healthcare model to reframe their own after-hours system, they may need to take additional factors into account, like primary care investments. Overall, their updated review suggests that by integrating primary care physicians with hospital emergency departments, the overall emergency department use has been reduced.

In-Depth [narrative review]:

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The authors reevaluated their narrative review, previously published in 2011, in include some of the updates that have been made to the Dutch after-hours care system over the past 5 years. Topics examined included collaboration with emergency departments, access to diagnostic facilities, and task substitution by nurses. In general, the authors found that the new collaborations between primary care physician cooperatives and emergency departments had reduced emergency department use from 13% to 22%. As well, at these new emergency care access points, primary care physicians treat about 75% of the self-referred patients who would have otherwise gone to the emergency department. This approach was considered a safe and cost-effective alternative to emergency department visits. In the future, such a system may serve as a key model for other countries trying to restructure their own after-hours care system.

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