New research says residents of post-acute and long term care (PALTC) facilities with same-day physician access experienced lower hospitalization and emergency department visit rates than those with longer wait times, according to a study in JAMDA.

In “Physician Availability in Long-Term Care Facilities and Resident Hospital Transfer: A Retrospective Cohort Study,” the authors administered a survey to Ontario, Canada, long term care facilities during a three-month period about their typical wait time for physician visits.

From this survey, researchers found a total of 52 facilities (32 percent) reported same-day physician access. Meanwhile, residents with same-day physician access had a 14 percent lower rate of emergency department visits and a 21 percent lower rate of hospitalizations than individuals in facilities without this capability.

The authors also found that availability of nurse practitioners who can assess and treat residents was independently associated with fewer emergency department visits and hospitalizations. Researchers, however, noted that 60 percent of facilities without same-day physician access didn’t have nurse practitioner access either.
The researchers suggested that many transfers could be prevented if all facilities had urgent access to either a physician or a nurse practitioner.

“We estimate that nearly one in six hospital admissions could be prevented if all [PA]LTC homes had same-day [physician] access,” the authors said.

“The potential impact is large because the effect size is large and the prevalence of same-day physician access is low in the study population.” They added that their findings suggest by improving urgent physician access in PALTC facilities could be cost-effective as well.

Researchers said they administered a survey to Ontario long term care facilities from March to May 2017 to collect their typical wait time for a physician visit.

“We linked the survey to administrative databases to capture other long term care home characteristics, resident characteristics, hospitalizations, and emergency department visits. We defined a cohort of residents living in survey-respondent homes between January and May 2017 and followed each resident for six months or until discharge or death,” the authors said.

This study was conducted by researchers at the Department of Medicine, Division of General Internal Medicine, Ottawa Hospital, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute; The Ottawa Hospital, Department of Medicine; University of Ottawa, School of Epidemiology and Public Health; and Bruyere Research Institute, Bruyere Centre of Learning, Research and Innovation in Long-Term Care.