Emergency department (ED) overcrowding is a global public health concern, and is associated with poor patient outcomes and high medical care costs.1,2,3 In Australia, the number of ED presentations has been rising since the early 2000s by 2–3% annually.4,5 In New South Wales, nearly half of all ED presentations during 2010–2014 were classified as low acuity presentations.6 Diverting people with low acuity conditions to primary care facilities,7 such as urgent care centres (UCCs),8 could alleviate ED overcrowding.9 While UCCs have been introduced in many countries, including Australia,10 their effectiveness and impact on health care costs are unclear.11 We therefore undertook a scoping review of published studies of the effect of UCCs on ED presentation numbers, their costs, and the experiences of patients and practitioners.
Methods
We conducted a scoping review of published qualitative or quantitative studies of the impact of UCCs in primary care and the number of ED presentations (Box 1). We searched for publications (to 28 August 2024) in the MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, and CINAHL databases, supplemented by internet searches and checking of reference lists for grey literature and other relevant publications (Supporting Information, supplementary methods). The review protocol is available upon request to the corresponding author.
Different types of UCC and similar primary care‐based clinics have been described in the literature:
- urgent care centres: for low acuity, urgent care, also available outside regular hours;12
- walk‐in centres: primary care facilities not located in hospitals, offering services without appointments, with or without extended hours;12
- after‐hours clinics: provide care between 5 pm and 8 am and on weekends and during holidays, and typically managed by the patients’ primary care provider;13
- community health centres: offer primary or secondary care in areas with restricted access to medical health care;14
- general practitioner cooperatives: operate outside regular hours, often near emergency departments;15,16 and
- patient‐centred homes: UCC or UCC‐like clinics that meet requirements with respect to care coordination and communication.17,18
To ensure the comprehensiveness of our review, we defined UCC broadly as a primary care‐based facility or model of care for people with low acuity conditions.19 The clinic must operate separately from EDs and other health services; it could be embedded within or share a building or area with ED or primary care services or be a standalone clinic.
Data extraction and synthesis
Two authors (FS, MF) extracted information from the publications, and one reviewer (FS) validated the information. We collected general information, mode of service delivery, and clinic type from all studies. For quantitative studies, we extracted numbers of ED presentations and hospital admissions, their costs, clinic location, workflow, and operating hours. For qualitative studies, we collected information about facilitators and barriers to UCC use and patient and provider experiences. All findings were narratively synthesised.
Results
We initially identified 2698 potentially relevant publications by database searching; after removing duplicates, we screened 1868 records for relevance. After excluding 1730 publications that were not relevant to our research question, we assessed the full text of 138 articles for eligibility according to our inclusion criteria; 51 articles were included in our review (Supporting Information, figure 1): 30 quantitative studies (Box 2)20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49 and 21 qualitative studies (Box 3).16,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69
All publications described studies in high income countries, including the United Kingdom (seventeen studies)20,23,24,33,37,43,50,52,55,57,58,62,64,66,65,67,68 and the United States (seven studies).21,27,28,32,41,47,48 The most frequently described care models were urgent care and walk‐in centres in the United Kingdom and the United States (thirteen studies),20,21,24,27,28,33,37,50,55,57,60,65,66 community health centres in the United States (three studies),28,41,48 in after‐hours clinics Australia and the United Kingdom (five studies), and general practitioner cooperatives in the United Kingdom and European countries (eleven studies).16,22,29,30,34,40,42,45,56,65,66
The study groups in the quantitative studies included clinic attendees (16 of 30 studies),20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35 the general population (eight studies),36,37,38,39,40,41,42,43 people with cancer44 or diabetes,45 clinicians,46 or people without health insurance,47,48 or people receiving home care.49 The study groups in the qualitative studies were staff members (seven of 21 studies),50,51,52,53,54,55,56 patients (eleven studies),16,40,57,58,59,60,61,62,63,64,65 or both patients and staff (three studies).66,67,68
Mode of delivery and workflow
Services were delivered in person in 40 of 51 studies,20,21,22,23,24,25,26,27,28,29,30,31,32,33,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,51,52,54,55,57,59,60,61,62,63 and nine studies reported hybrid delivery (for example, both in person and by phone).16,34,50,56,58,64,65,67,68
UCCs were led by general practitioners in 41 of 51 studies.20,22,23,24,25,26,27,28,29,30,31,34,35,36,37,38,39,40,41,42,43,44,45,46,49,50,52,53,55,56,58,59,61,62,63,64,65,66,67,68,69 Triage was performed by nurses (six studies),16,50,53,55,58,61 general practitioners (three studies),29,52,57 a paramedic (one study),59 or by different people in different positions at different centre types (nine studies).37,40,51,54,60,65,66,67,68
In the twenty‐four publications that reported opening times, UCCs were open 24 hours a day (two studies),22,26 after normal hours (eighteen studies),20,25,27,29,30,31,33,36,37,38,39,41,42,43,45,46,49 for a limited number of hours (two studies),21,40 or during standard work hours (two studies).23,28 In eighteen studies UCCs were standalone clinics,20,21,22,24,26,27,28,31,32,37,41,42,45,47,51,56,59,63 in ten studies they were located within primary care,23,25,29,30,36,38,39,40,46,49 in eight studies next to EDs or hospitals,33,34,35,44,50,52,57,58 and in two studies within a community or health centre;43,61 one publication included different types of UCC arrangement.65
In 34 of 51 studies, the clinics primarily managed people with non‐urgent conditions or minor illnesses,16,20,22,23,24,25,26,28,29,31,33,34,36,37,38,40,41,42,43,46,49,50,51,53,56,57,58,60,61,62,64,65,67,68 and in eight studies the focus was non‐emergency but urgent conditions;21,27,35,39,40,52,55,59 in other studies, the focus was psychiatric care,54 low acuity presentations related to cancer treatment,44 diabetes management,25 chronic conditions,45 and people without health insurance with low acuity conditions.47 Other studies compared several clinic models without defining their scope32,48,60,66 or did not report this aspect.30,63
Quantitative studies
Twenty‐four of the 30 quantitative studies were longitudinal, six were pre–post evaluations.20,22,24,26,34,44 Four longitudinal studies were longer than five years.30,36,39,45 Nineteen studies assessed outcomes before and after program establishment, eleven used another comparator, such as matched controls. Eleven studies measured the number of low acuity ED presentations and the number of hospitalisations from the ED. Patient waiting time was not evaluated in any study.
Emergency department presentations
Fewer ED presentations were reported by all seven quantitative studies of after‐hours clinics25,31,36,38,39,43,46 and one of two of 24‐hour clinics;23 a study of people receiving home care found that after‐hours care was associated with fewer same‐day ED presentations.49 Two of six studies of general practitioner cooperatives found no effect on ED visit numbers,22,40 three found reductions.30,34,42
Four of five walk‐in centre studies reported reduced ED visit numbers;20,21,27,37 two United Kingdom studies reported increased workloads for minor injuries units,24 and a study including multiple sites found no difference in ED visit numbers.33 A UCC with a focus on low acuity presentations by people being treated for cancer found no effect on the number of ED presentations.44
Community health centres had no effect on the number of ED presentations but were associated with lower hospitalisation rates in three of seven studies26,28,48 or unchanged hospitalisation rates in one;47 a study of patients without health insurance found that the number of ED presentations was reduced.41 Further, patient‐centred medical homes in the United States32 and participation of general practitioners in community health centres (a “medical home” care model in Italy) were associated with reduced inappropriate ED use.45 Acute care collaboration did not affect the number of ED presentations, but was associated with a higher hospitalisation rate.35
Of nine studies that reported proportional changes in ED presentation numbers, three reported 2–3% reductions,21,39,43 four reductions of 8–10%,20,23,36,42 and one a reduction of more than 50%.31 One study reported a 2% reduction in the number of inappropriate ED presentations.45
Hospital admissions from the emergency department
Effects on the number of hospital admissions from the ED were reported in eleven studies, they were lower in seven (investigating an urgent cancer care centre, four community health centres, and a general practitioner cooperative).26,32,34,44,45,47,48 They were higher in studies of a United Kingdom walk‐in UCC27 and a general practitioner cooperative in Ireland,29 and there was no change in studies of a general practitioner cooperative30 and an acute care collaboration centre.35
Referrals
A United Kingdom walk‐in centre was associated with reduced numbers of primary care presentations;20 studies in a community health centre26 and a general practitioner cooperative34 reported increased numbers of primary care referrals.
Qualitative studies
Ten of 21 qualitative studies were based on self‐completed surveys16,55,56,57,62,63,64,65,67,69 and eight on semi‐structured interviews;52,53,58,59,61,66,67,68 one study included both approaches.50 Two studies used focus groups51,54 and one retrospective chart reviews.60 Three quantitative studies also included assessment of user feedback.25,33,47
Facilitators of the use of urgent care centres
The unavailability of doctors or appointments was a frequent reason for people using UCCs;16,57,59,61,63 they were regarded more quickly accessible than EDs,59,61 a better alternative,25,47,59,66,69 and did not require appointments.47,51,57,63,67 Other facilitators included the urgent need for health care,47,61 clinically healthy people seeking reassurance (“worried well”),16,52 not being registered or medically insured,47,52 and proximity to home or work.52,57,65,66 Dissatisfaction with their doctors,52,57 popularity of the clinic or recommendations from others,52,57,61 and better equipment than primary care clinics52 were other motivators for people to use UCCs. From an organisational perspective, strong commitment and leadership by doctors68 and a clear understanding of the role of the clinic among staff members56 were critical. Staff experience in triage53 and the availability of telephone advice67 were also important.
Barriers to the use of urgent care centres
Poor public awareness and understanding of the role of UCCs was often reported.16,51,52,66,69 and providers often do not understand the model of care.20,67 Concerns about duplicating ED and family practice services were expressed, and about private clinics losing patients to free UCCs,20,51,66 although one United Kingdom study reported that duplication was not a concern.68 Primary care and ED care providers had mixed views about the impact of UCCs on ED load,51,66,68 the appropriateness of ED attendance,51 and the cost‐effectiveness of UCCs.66 The lack of standardised protocols67 and low standards of safety for staff members were also reported.51,54 Other barriers included wide variations in clinic‐to‐clinic staffing levels and differences in triage systems,67,68 as well as inadequate public involvement in planning and operations.68
Patient experiences
People who attended UCCs reported shorter57,68 or acceptable waiting times (within 24 hours),63 high satisfaction58,59 (more than 80%16,62,63 or 90%68) or similar satisfaction as with family practices,60 and they preferred them to home visits16,62,63 or visiting EDs.62,65,69 People also reported promptness,58,59 friendly staff,58,64 and quality information,57,58 but triage experiences were mixed;16,58 in‐person triage was preferred to telephone triage.64,65 Deputising UCCs (involving outside doctors) were generally preferred to practice‐based (co‐located) UCCs (which rely on rosters or on‐call arrangements for regular general practitioners),65 but comparisons with general practice cooperatives found less satisfaction62 or no difference.64 People who visited a general practitioner cooperative were less likely to need further visits to doctors.64
Negative experiences included lower quality advice from triage nurses,16 unfamiliarity with staff members,58,64 and poor continuity of care;58, continuity of care was also of concern for health care professionals.51 In a survey, more than 50% of people had consulted their regular doctors after visiting UCCs.33
Provider experiences
Providers reported improved collaboration between UCCs and general practices68 and the police;54,55,68 liaison structures were crucial.50,67 Embedded models promoted teamwork but role confusion and differing risk tolerance could be a problem.50 General practitioners had mixed experiences with specialists53,54,55,56 because of mismatched service scopes.53,67 Providers viewed UCCs as helpful in reducing ED presentation numbers66 and improving care quality68 and care access.66 Doctors preferred standalone UCC models56 but were concerned about increased workload,54,55,56,66 scope creep,50 inconsistent triage guidelines,50,53,66,67 patient illegitimacy (for example, unregistered or undocumented people, asylum seekers),52,53,56 and safety questions.54,55,56 Other concerns included a lack of training and equipment67,68 and of established connections between patients and doctors.54,55,58
Costs
Six studies evaluated the costs of UCCs.21,32,33,35,43,46 A United Kingdom study projected US$825 902 in savings by providing walk‐in clinics as alternatives to EDs;21 another reported lower annual per beneficiary payments at urgent care centres.32 A Canadian study estimated that $149 was saved for each ED visit averted by increased after‐hours services.46 In the United Kingdom, one study found no change in per patient costs after establishing walk‐in centres,33 but another reported a 26% cost reduction for minor referrals.43 In the Netherlands, total costs were higher for shared triage clinics than for standalone walk‐in clinics.35
Funding models
Twenty‐two studies reported government funding for UCCs, and four mixed funding, including a combination of government, non‐profit, and private funding; one study reported private funding. Four studies reported that the service was free20,31,39,40 and five implied that it was free.23,24,33,57,61 Other reimbursement models included fee‐for‐service22,60 and pay‐for‐performance models.38,46 One study noted bulk‐billing was not available at the service;36 another analysed insurance claims data without specifying the funding model.35 Two studies were of services with income‐sensitive sliding fee scales.41,48 A mixed public–private funding model in one quantitative study was associated with more ED visits but unchanged hospital admission number.28
Discussion
We found that walk‐in and after‐hours clinics could reduce the number of ED presentations and health care costs. Most UCCs were led by general practitioners, offered care for people with a variety of health problems, and were free of charge. People were highly satisfied with these services, but patients and health care providers reported concerns about the lack of continuity of care, and clinicians reported that interdisciplinary collaboration, safety, and standardised protocols could be improved.
The impact of UCCs is often context‐specific. Most studies with study groups drawn from the general population found reduced ED visit numbers,25,31,36,38,39,43,46 while studies that assessed people with specific medical risks often did not.44,49 Qualitative findings suggest that standalone UCC models62,64 are generally preferred to co‐located clinics,35 but the number of studies was small. UCCs are not the sole solution for ED overcrowding. While they can increase access to health care and manage people with low acuity conditions, they do not remove the root causes of ED pressure, including access block, bed shortages,70 and suboptimal outpatient scheduling.71 Solutions that avoid mismatches between causes and solutions must be tailored according to local conditions, and will require additional resources and political commitment.72,73
Clinicians were concerned about the lack of standardised protocols, especially with respect to triage. Which low acuity presentations should be considered “inappropriate” and managed in primary care is controversial; studies in Australia and the United Kingdom suggest that 10–25% of ED patients could be diverted to primary care.74,75 A systematic review of studies during 2000–2014 also found that the increased workload is a problem for doctors.76 Additional training for doctors is also crucial, as many reported working outside their usual scope of practice.50,54,55,56,66 Clinicians also raised concerns about unregistered and uninsured people attending UCCs; people in these groups, whose health is often poorer than that of other people,77,78 find health care easier to access at UCCs because of the looser identity requirements. These findings indicate the importance of public health education, official documentation support for patients, proper training for doctors, and the establishment of UCC standards in countries that lack them, including Australia.
Patient satisfaction with UCC services is high and similar to that with comparable services. The facilitators of people using UCCs in our review were similar to those identified by an umbrella review, including limited access to general practitioners, perceived urgency of the need for care, and convenience.79 A comparative study in the United Kingdom, United States, and New Zealand found that reasons for choosing UCCs can involve demographic, circumstantial, and clinical factors.80 Continuity of care is valued,81,82 but often cannot be achieved in primary care‐based urgent care general practice because of access, funding, and cost barriers.83
Policy implications
Public education about appropriate choices of care is needed. Training and workload management for doctors are important for ensuring safety and care quality in UCCs. Establishing a national standard is critical in countries like Australia, where the Royal New Zealand College of Urgent Care standard is currently used.84 UCCs alone cannot solve ED overcrowding, and strategies for optimising existing services are needed, including increasing the availability of doctors and reducing waiting times.57,85 Information regarding the comparative effectiveness and cost‐effectiveness of privately and publicly funded UCCs is limited. In countries where UCCs are well established, such as the United Kingdom and the United States, refining regulations, ensuring quality, and maintaining affordability should be priorities. In Australia, where UCCs are newer, government support is crucial, as is assessing their effectiveness, service uptake by the public, and financial incentives for both providers and patients. In our review, the Australian findings were similar to those of overseas studies in that after‐hours care was reported to reduce the number of ED presentations,31,36 and people prefer UCCs to EDs.59 As health care demand rises with the ageing of populations in many countries,86 including Australia, primary care UCCs will probably be vital for alleviating the pressure on EDs.
Limitations
As a scoping review, we did not undertake formal quality appraisal and we used broad inclusion criteria, as a wide variety of study types of various UCC models have been reported, and there is no globally accepted definition of “urgent care centre”.
Conclusion
UCCs can help reduce the number of ED presentations; walk‐in clinics and after‐hours clinics can be effective and reduce health care costs. Our findings can inform discussions about the effectiveness of UCC‐like clinics for diverting people with non‐urgent needs from EDs. While patient satisfaction with UCCs is high, public health education could guide people to seek appropriate care for their health problems. Training in the management of conditions frequently seen in UCCs, especially for nurse practitioners, is needed to ensure consistent, effective care. Published standards are needed in Australia to improve safety and consistency and to assess the effectiveness and cost‐effectiveness of UCCs. Workload management, improved interdisciplinary communication and collaboration, and training are important considerations for clinicians.
Received 2 August 2024, accepted 23 December 2024
Box 1 – Inclusion and exclusion criteria for our scoping review of published studies of the impact of primary care urgent care centres (UCCs) on the number of emergency department (ED) presentations
|
Criterion |
Inclusion criteria |
Exclusion criteria |
|||||||||||||
|
|
|||||||||||||||
|
Participants |
|
|
|||||||||||||
|
Intervention |
|
|
|||||||||||||
|
Comparator |
|
|
|||||||||||||
|
Setting |
|
|
|||||||||||||
|
Study type |
|
|
|||||||||||||
|
Outcome |
|
|
|||||||||||||
|
Language of publication |
|
|
|||||||||||||
|
|
|||||||||||||||
|
|
|||||||||||||||
Box 2 – Summary of thirty quantitative studies included in our scoping review of published studies of the impact of primary care urgent care centres (UCCs) on the number of emergency department (ED) presentations
|
Reference |
Study design; participants (country) |
Intervention (type; mode of delivery; location) |
Comparator |
Summary of findings |
Funding source, funding model and cost assessments |
||||||||||
|
|
|||||||||||||||
|
Moore, 197228 |
Quantitative observational study; Charlestown residents who visited the emergency room (USA) |
Neighbourhood health centre; in‐person only; standalone |
Before program |
Increased ED visits; no change in hospital use by the community. |
Government (Medicare and welfare), and private insurance and payments |
||||||||||
|
Maynard, 198326 |
Quantitative observational study, Mosgiel residents who attended the accident and emergency department of Dunedin Hospital (New Zealand) |
Health centre; in‐person only; standalone |
Before program |
No reduction in overall ED use by health centre patients, nor in opening hours of the health centre, or for subgroups thought likely to prefer the new facility. |
Not reported. |
||||||||||
|
Merritt, 200027 |
Quantitative observational study, patients who visited the urgent care centre during August 1996 (USA) |
Urgent care centre, in‐person only, standalone |
Before program |
A first‐time visit to the UCC was associated with a 48% reduction in ED visits for adults and a 28% reduction for children during the six months following the visit. |
Not reported. |
||||||||||
|
Hsu, 200324 |
Quantitative observational study; nine of thirteen general practices with patients in Loughborough and three of four practices with patients in Market Harborough (UK) |
Walk‐in centre; in‐person only; standalone |
Before program |
No effect on local general practitioners’ workload; local minor injuries unit (in same building as walk‐in centre) increased (adjusted RR, 1.10; 95% CI, 1.00–1.21). |
Government‐funded (National Health Service). |
||||||||||
|
Chalder, 200337 |
Quantitative observational time series analysis; EDs, general practices and out‐of‐hours services (UK) |
Walk‐in centre; in‐person only; standalone |
Before program |
Reduced ED visits and general practice consultations near walk‐in centres: intervention: –173.3 (95% CI, –334 to –12) per 1000 patients per month; control: –3 (95% CI, –145 to 139) per 1000 patients per month; no influence on out‐of‐hours service consultations,: –0.5 (95% CI, –0.95 to –0) per 1000 patients per month. |
Government agency (National Health Service). |
||||||||||
|
van Uden, 200442 |
Quantitative observational study; Limburg residents (Netherlands) |
General practitioner cooperatives; in‐person only; standalone |
Before program |
Reorganisation of out‐of‐hours primary care has shifted patient contacts from emergency care to primary care; demand for emergency care reduced by 8.2% during normal hours and 8.9% outside normal hours. |
Not reported. |
||||||||||
|
Horwitz, 200547 |
Quantitative observational study; uninsured patients (at least 18 years of age, not being seen for substance abuse or mental health only) (USA) |
Community Access Program; in‐person only; standalone |
Control group with usual care |
No change in ED visits and primary care contact (RR, 1.07; 95% CI, 0.72–1.58). |
Government agency (Health Resources and Services Administration). |
||||||||||
|
van Uden, 200534 |
Quantitative observational study; all patient contact registration forms in Maastricht (Netherlands) |
Primary care physician cooperative; hybrid; within ED |
Before program |
Use of out‐of‐hours hospital emergency care reduced by 53%; proportion of patients using primary care increased by 25%. |
Not reported. |
||||||||||
|
Salisbury, 200733 |
Quantitative observational study; sites with new walk‐in centres (UK) |
Walk‐in centre; in‐person only; within ED |
Before program |
No increase in attendance at sites with walk‐in centres; difference in change: 542 (95% CI, –347 to 1431) patients per month; considerable variability between sites. |
Government agency (National Health Service). |
||||||||||
|
O'Keeffe, 200829 |
Quantitative observational study; out‐of‐hours attenders (Ireland) |
General practitioner cooperatives; in‐person only; within general practitioner clinic |
Before program |
No significant change in total out‐of‐hours ED attendances (1003 v 998) or workload; no significant drop in unnecessary attendances (8.5% to 6.2%; P = 0.05) and no change in admissions, transfers, or minor injury cases over three‐month winter period. |
Not reported. |
||||||||||
|
Rust, 200941 |
Quantitative observational study; counties in Georgia (USA) |
Community health centre; in‐person only; standalone |
Non‐community health centre counties |
Without clinic: more ED visits by uninsured patients in rural counties (adjusted RR, 1.21; 95% CI, 1.02–1.42), but not insured patients (adjusted RR, 1.06, 95% CI, 0.92–1.22). |
Government agency (sliding scale fees subsidised by grants from the Health Resources and Services Administration Bureau of Primary Health Care). |
||||||||||
|
Buckley, 201036 |
Quantitative observational retrospective time series; residents of Wagga Wagga (Australia) |
After‐hours clinic; in‐person only; within pre‐existing general practitioner clinic |
Before program |
Low acuity ED presentations reduced by 8.2% (95% CI, 6.2–10.2%). |
Government agency (Riverina division of general practice). |
||||||||||
|
O'Kelly, 201030 |
Quantitative observational study; all attenders (Ireland) |
General practitioner cooperative; in‐person only; within general practitioner clinic |
Outside general practitioner cooperative hours |
ED visits during cooperative hours declined as proportion of all attendances for triage categories 4 and 5 (1999, 46%; 2007, 24%). ED attendances for triage categories 4 and 5 fell by 54% (P = 0.033). |
Not reported. |
||||||||||
|
Philips, 201040 |
Quantitative observational study; patient contacts at the ED in two hospitals and with general practitioners on call in the intervention region (Belgium) |
General practitioner cooperative; in‐person only; within general practitioner clinic |
Before program |
One year after introduction, more people seek help at the general practice cooperative (OR, 1.65; 95% CI, 1.44–1.88); no effect on ED visits. |
Not reported. |
||||||||||
|
Jones, 201125 |
Quantitative observational study; patients of the local hospital ED (Canada) |
After‐hours clinic; in‐person only; within general practitioner clinic |
Before program |
During after‐hours clinic hours (6–10 pm, Monday to Thursday): 38 fewer ED visits per month (P = 0.009) and 49 fewer semi‐urgent ED visits (triage category 4) per month (P = 0.001; reduced from 7.9 to 4.7 per 1000 population per month) over fourteen months. |
Government agency (health care for all Albertans is provided by the provincial government). |
||||||||||
|
Arain, 201520 |
Observational longitudinal; clinic attenders (UK) |
Walk‐in centre; in‐person only; standalone |
Before program |
Monthly number of general practitioner‐type attendances at adult ED reduced by 8% (95% CI, 1–16%), but not at the children's ED or minor injury unit. |
Not reported. |
||||||||||
|
Pines, 201532 |
Quantitative observational study; patient‐centred medical home practices (USA) |
Physician practice connections: patient centred medical home; in‐person only; standalone |
Not patient‐centred medical homes |
Twelve to thirteen fewer ED visits per 100 beneficiaries over two years in patient‐centred medical homes compared than for people attending non‐recognised practices; seven to eight fewer visits for ambulatory care‐sensitive conditions; no impact on inpatient admissions (2008–2010, Medicare data). |
Not reported. |
||||||||||
|
Wright, 201548 |
Quantitative observational study; people eligible for both Medicare and Medicaid (dual eligibles) (USA) |
Federally qualified health centre; in‐person only |
Non health centre users |
Among dual eligibles, preventable ED visits by smaller proportion of people using federally qualified health centres (12.0%) than for other people (14.7%) during 2008–2010; overall number of ED visits for ambulatory care‐sensitive conditions was higher for centre users in most groups, but fewer preventable hospitalisations for Black (16% fewer) and Hispanic (13% fewer) patients older than 65 years of age. |
Government agency (federal). |
||||||||||
|
Dolton, 201623 |
Quantitative observational study; all Central London patients (UK) |
7‐day clinic; in‐person only; within general practitioner clinic |
General practitioner practices without 7‐day opening |
Reduced ED visits by patients of pilot practices; mean weekly number of minor cases: intervention, 8.0 (SE, 7.0); control, 7.3 (SE, 5.0); mean weekly number of minor cases: intervention, 13.8 (SE, 6.4); control, 14.0 (SE, 10.8). |
Government agency (Prime Minister's Challenge Fund; established in 2013 to pilot 7‐day opening of general practices. |
||||||||||
|
Whittaker, 201643 |
Quantitative observational study; hospital administrative data (UK) |
After‐hours clinic; in‐person only; within primary community centres |
Before program |
Expanding access was associated with reduced ED visits with minor problems in first twelve months by 26.4% (95% CI, 14.2–38.6%). |
Government agency (National Health Service). |
||||||||||
|
Colliers, 201722 |
Quantitative observational study; all patients (Belgium) |
General practitioner cooperatives; in‐person only; standalone |
Before program, and other regions |
No change in ED presentations (OR, 0.96; 95% CI, 0.91–1.1). |
Government agency (National Institute for Health and Disability Insurance). |
||||||||||
|
Payne, 201731 |
Mixed quantitative and qualitative study; people who presented to the Bathurst after‐hours general practice clinic (Australia) |
After‐hours clinic; in‐person only; standalone, no appointments |
Before program |
41% reduction in non‐urgent ED presentations (418.5 to 245.5 per year) over two years after opening. |
Government agency (Medicare covers fees for service; no out‐of‐pocket expenses for patients). |
||||||||||
|
Pacheco, 201939 |
Quantitative observational study; Talcahuano Health District (Chile) |
Urgent care centre (after‐hours care hybrid); in‐person only; within general practitioner clinic |
Before program |
ED visits reduced by 2.7% (95% CI, 1.4–4.0%); same‐day visits to primary care centres reduced by 5.7% (95% CI, –11.1% to –0.35%),possibly affecting quality of primary care. |
Government agency (public health insurance fund; care is free of charge at point of care for most users). |
||||||||||
|
Devlin, 202046 |
Quantitative observational study; physicians who claim after‐hour incentives (Canada) |
After‐hours clinic; in‐person only; within general practitioner clinic |
Physicians who did not submit claims for after‐hour incentives under the Ontario Health Insurance Plan |
Number of less urgent ED visits reduced by 5.5% from 2004 to 2007; cost savings of about $149 per averted ED visit. |
Government agency. |
||||||||||
|
Jones,202049 |
Quantitative observational study; home care patients aged 19 years or older in Ontario (Canada) |
After‐hours clinic; in‐person only; within general practitioner clinic |
Control period |
Smaller rise in risk of same day after‐hours ED visits for people with after‐hours primary care (OR, 1.16; 95% CI, 1.01–1.33) than for other patients (OR, 1.33; 95% CI, 1.21–1.47). The effect was larger for ED visits not leading to admission. |
Government agency (publicly funded adult, home care patients in Ontario). |
||||||||||
|
Baughman, 202121 |
Observational retrospective cohort analysis; established patients at clinic (USA) |
Walk‐in centre; in‐person only; within established primary care provider office |
Before program |
Walk‐in clinic at primary care provider office led to reduction in low acuity ED visits (0.4 per 100 patients) over one year, despite absolute visit numbers increasing. |
Not reported. |
||||||||||
|
Hong, 202138 |
Quantitative observational study; Ontario residents (Canada) |
After‐hours clinic; in‐person only; within general practitioner clinic |
Before program |
Incentives for physicians to provide after‐hours primary care reduced some less urgent ED visits by 1.26 (95% CI, 1.04–1.48) per 1000 patients per month. |
Government agency (Ontario government). |
||||||||||
|
Lippi Bruni, 202345 |
Quantitative observational study; all patients with type 2 diabetic (Italy) |
General practitioners joining community health centres; in‐person only; standalone |
Patients enrolled with general practitioners not in a community health centre |
Reduction in inappropriate ED visits by 1.5–1.7 percentage points per patient per year during weekday daytime hours; no effect on night or weekend visits. |
Government agency (Ministry of Health defined community health centres as national priority). |
||||||||||
|
Galloway, 202344 |
Quantitative observational interrupted time series; people with cancer and serious blood disorders experiencing complications of disorder or treatment (Canada) |
Urgent cancer care centre; in‐person only; in hospital |
Before program |
No change in ED visits (RR, 0.96; 95% CI, 0.86–1.08), primary care clinician visits, or hospitalisations. |
Not reported. |
||||||||||
|
Wackers, 202335 |
Quantitative observational study; patients who visited acute care collaborations (Netherlands) |
Acute care collaboration; in‐person only; within ED |
Stand‐alone after‐hours primary care provider |
Collaboration between EDs and after‐hours primary care did not alter ED use (OR, 1.01; 95% CI, 1.00–1.03); hospital admission rates and costs rose. |
Not reported. |
||||||||||
|
|
|||||||||||||||
|
CI = confidence interval; OR = odds ratio; RR = risk ratio; SD = standard deviation; SE = standard error; UK = United Kingdom; USA = United States of America. |
|||||||||||||||
Box 3 – Summary of twenty‐one published qualitative studies of primary care urgent care centres (UCCs) included in our scoping review
|
Reference |
Study design; population characteristics (country) |
Intervention (type; mode of delivery; location) |
Summary of findings |
Funding model |
|||||||||||
|
|
|||||||||||||||
|
Rizos, 199063 |
Survey; patients (Canada) |
Walk‐in clinic; in‐person only; located in shopping mall |
Main reasons for clinic visits: convenience, timely access, no appointments needed. Most patients would have visited other clinics or the ED if theirs were closed. Despite most visits being outside regular hours, satisfaction was high. |
Not reported. |
|||||||||||
|
Salisbury, 199764 |
Postal survey; patients (UK) |
General practitioner cooperative; hybrid (phone call, face‐to‐face, or home visit); not reported |
Patients who received telephone advice, preferred their own doctor or a home visit, or experienced longer waiting times reported lower overall satisfaction. Satisfaction levels varied more within patient groups than between models for out‐of‐hours care. Shifting to a primarily telephone‐based advice service could increase dissatisfaction. |
Not reported. |
|||||||||||
|
Hallam, 199968 |
Semi‐structured interviews and postal surveys; general practitioners, health service managers, purchasers, providers, and patients (UK) |
UCC; hybrid (in‐person, telephone, home visits); various locations (hospital, accident and emergency, general practitioner health centres, community centres); standalone |
General practitioners find public involvement lacking. Transitioning to cooperative care is resisted because of resource limitations. Recruiting general practitioners requires effort, patient satisfaction is high. Concerns persist about the model's long term viability. Suggestions include public education and improving general practitioner skills. |
Government and private. |
|||||||||||
|
Shipman, 200065 |
Survey; general population attending the services (UK) |
General practitioner cooperative; hybrid (phone call, face‐to‐face or home visit); not reported |
Patients were satisfied with cooperative, practice‐based, or deputising services, but were concerned about service quality. Satisfaction varied more with cooperative service delivery; concerns about telephone consultations and access to out‐of‐hours care. |
Not reported. |
|||||||||||
|
Brown, 200251 |
Focus group; physicians (Canada, UK) |
Walk‐in centre; in‐person only; standalone |
Growth of clinics driven by increasing patient expectations for convenient health care and reduced availability of family physicians. Need to increase accountability of physicians and patients and to alter the framework of primary health care delivery to bridge the gap. |
Not reported. |
|||||||||||
|
McKinley, 200262 |
Survey; all who requested care after their practice had closed on weekday evenings and weekends (UK) |
Out‐of‐hours primary care; in‐person only; not reported |
Meeting or failing to meet patients’ care expectations predicts their satisfaction with out‐of‐hours care. Providers should manage patient service expectations to reduce dissatisfaction. |
Not reported. |
|||||||||||
|
Hutchison, 200360 |
Cohort study; patients (Canada) |
Walk‐in clinic; in‐person only; not reported |
Family practice patients were most satisfied with waiting times; family practices and walk‐in clinics were rated more positively than EDs on all satisfaction dimensions. However, overall care quality was scored higher in walk‐in clinics and EDs than in family practices. |
Private (fee for service). |
|||||||||||
|
Bury, 200567 |
Questionnaire/survey and semi‐structured interviews; physicians (Ireland) |
General practitioner out‐of‐hours cooperative; hybrid (telephone follow‐up and in‐person); various locations |
More clarity required about the mutual support level of general practitioner cooperatives and ambulance services, including procedures for call transfers, understanding each other's roles, and developing common procedures. |
Not reported. |
|||||||||||
|
Jackson, 200561 |
Semi‐structured interviews; patients (UK) |
Walk‐in clinic; in‐person only; within minor injuries unit |
Patients note the clinics helped improve health care accessibility by offering an alternative for professional advice and treatment. They alleviate pressure on general practice and accident and emergency facilities, empowering people to satisfy their health care needs responsibly. |
Government (National Health Service) |
|||||||||||
|
van Uden, 200556 |
Survey informed by general practitioner interviews; general practitioners (Netherlands) |
General practice cooperatives; hybrid (phone call, face‐to‐face or home visit); standalone |
General practitioners are generally satisfied with cooperatives for out‐of‐hours care, more with standalone cooperatives than integrated ones. |
Not reported. |
|||||||||||
|
Egbunike, 201058 |
Semi‐structured telephone interviews and thematic analysis; service users or carers (UK) |
Out‐of‐hours clinic; hybrid (telephone triage and in‐person); hospital and standalone locations |
Service users need streamlined and flexible triage systems to improve satisfaction and manage their conditions. Better information and education about services are essential for optimal user benefit and satisfaction, potentially affecting decisions about care. |
General practitioner cooperative, non‐for‐profit funding; hospital based, government funded and private out‐of‐hours service; privately funded. |
|||||||||||
|
Philips, 201069 |
Survey; patients (Belgium) |
General practitioner deputising services; in‐person only; home based or ED care |
Of 350 respondents, 99 (98.6%) were aware of the ED, 82 (81.7%) knew about the clinic. Reasons for favouring the ED: easy access, thorough explanations from doctors, delayed payment deadlines. Reason for favouring the clinic: shorter waiting times. |
Not reported. |
|||||||||||
|
Johansen, 201154 |
Focus groups; general practitioners (Norway) |
Casualty clinic; in‐person only; various |
General practitioners found out‐of‐hours psychiatry difficult because of uncertainty and inadequate support, potentially affecting care quality. To maintain emergency mental health care, better support for general practitioners outside normal hours is essential. |
Not reported. |
|||||||||||
|
Smits, 201216 |
Survey; patients (Netherlands) |
General practitioner cooperatives; hybrid (phone call, face‐to‐face or home visit); not reported |
Patients were satisfied with general practitioner cooperatives, and it was increasing four years after opening. Areas where improvement is needed include advice quality, waiting times, and information provided. |
Not reported. |
|||||||||||
|
Amiel, 201457 |
Survey; urgent care centre service users (UK) |
UCC; in‐person only; co‐located with emergency department |
Primary motivations for service use: access to care, receiving prescription medication, dissatisfaction with general practitioner. The clinic primarily attracted healthy young adults, often registered with general practitioners, seeking convenience and ease of access. Need for patient education and self‐management. |
Government agency (National Health Service). |
|||||||||||
|
Arain, 201566 |
Interviews; health care professionals (consultants, general practitioners, nurses) and managers (general practitioner‐led walk‐in centre managers, primary care trust managers) (UK) |
Walk‐in centre; in‐person only; not reported. |
Daytime visits to adult ED reduced after opening of the clinic, but not at night. Survey responses indicated that some people were redirected from the ED. |
Government and private. |
|||||||||||
|
Greenfield, 201652 |
Phenomenological study with semi‐structured open‐ended interview; staff (UK) |
UCC; in‐person only; co‐located with accident and emergency department |
Four main themes: confusion about choices, overt reasons, covert motives, question of legitimacy. Participants acknowledged patients’ use of UCCs because of convenience, urgency, anxiety, and lack of self‐care skills. |
Commissioned by National Health Service. |
|||||||||||
|
Keizer, 201655 |
Cross‐sectional survey; general practitioners (Netherlands) |
General practitioner cooperative (out‐of‐hours primary care); in‐person only; not reported |
Of 428 respondents, increased workload reported by 370 (86.5%) of respondents, and 393 (91.8%) believed patient contacts could be reduced; 323 (75.4%) cited societal expectations for 24‐hour service as key reason for non‐urgent visits to cooperatives; 359 (83.9%) saw current telephone triage methods as contributing to high cooperative use. Proposed solutions included co‐payments, stricter triage, expanding telephone consultation roles, and patient education. |
Not reported. |
|||||||||||
|
Ablard, 201750 |
Survey and semi‐structured interviews with thematic analysis, lead emergency department consultants (UK) |
UCCs and general practitioner out‐of‐hours; hybrid; co‐located next to ED |
Four themes: justification for the service, level of integration, referral processes, sustainability. Need to develop a service within or near the ED, and to establish efficient triage procedures. |
Government agency (National Institute for Health Research Clinical Applications Research Centre Yorkshire and Humber). |
|||||||||||
|
Heutmekers, 202253 |
Semi‐structured face‐to‐face interviews; health care professionals (Netherlands) |
Out‐of‐hours general practitioner cooperative for people with intellectual disabilities; hybrid (phone call and in person); not reported |
Quality of care is shaped more by the organisational environment rather than medical factors, indicating the need for clear standards for roles and responsibilities of health care professionals to improve accessibility and quality of care for people with intellectual disabilities. |
Not reported. |
|||||||||||
|
Greene, 202359 |
Semi‐structured telephone interviews and thematic analysis; service users and relatives (Australia) |
Complex And RestorativE centre; in‐person only; standalone |
Most participants preferred the centre to the nearby ED for its calm atmosphere and specialised geriatric medicine staff. Programs aimed at avoiding ED visits would be a viable alternative for older people needing urgent care, improving public health systems and user satisfaction. |
Not reported. |
|||||||||||
|
|
|||||||||||||||
|
ED = emergency department; UK = United Kingdom. |
|||||||||||||||
- Feby Savira1
- Madison Frith1
- Clarissa J Aditya1
- Sean Randall1
- Naomi White2
- Andrew Giddy2
- Lauren Spark3
- Jamie Swann2
- Suzanne Robinson1
- 1 Institute for Health Transformation, Deakin University, Melbourne, VIC
- 2 Western Victoria Primary Health Network, Ballarat, VIC
- 3 Melbourne, VIC
Open access:
Open access publishing facilitated by Deakin University, as part of the Wiley – Deakin University agreement via the Council of Australian University Librarians.
The study was funded by Western Victoria Primary Health Network as part of the Priority Primary Care Centre evaluation program. The funders had no role in the planning, writing, or publication of this review. We acknowledge the support received from the Western Victoria Primary Health Network to conduct this study and to ensure evidence‐based research in Victoria and Australia.
Naomi White, Andrew Giddy, and Jamie Swann are employees of the Western Victoria Primary Health Network.
- 1. Javidan AP, Hansen K, Higginson I, et al. International Federation Emergency Department Crowding and Access Block Task Force. The International Federation for Emergency Medicine report on emergency department crowding and access block: a brief summary. Emerg Med J 2021; 38: 245‐246.
- 2. McKenna P, Heslin SM, Viccellio P, et al. Emergency department and hospital crowding: causes, consequences, and cures. Clin Exp Emerg Med 2019; 6: 189‐195.
- 3. Di Somma S, Paladino L, Vaughan L, et al. Overcrowding in emergency department: an international issue. Intern Emerg Med 2015; 10: 171‐175.
- 4. Lowthian JA, Curtis AJ, Jolley DJ, et al. Demand at the emergency department front door: 10‐year trends in presentations. Med J Aust 2012; 196: 128‐132. https://www.mja.com.au/journal/2012/196/2/demand‐emergency‐department‐front‐door‐10‐year‐trends‐presentations
- 5. Toloo G, Fitzgerald G, Aitken P, et al. Emergency health services: demand and service delivery models. Monograph 1: literature review and activity trends. Brisbane: Queensland University of Technology, 2011. https://eprints.qut.edu.au/46643/1/46643.pdf (viewed Jan 2024).
- 6. Dinh MM, Berendsen Russell S, Bein KJ, et al. Statewide retrospective study of low acuity emergency presentations in New South Wales, Australia: who, what, where and why? BMJ Open 2016; 6: e010964.
- 7. Savioli G, Ceresa IF, Gri N, et al. Emergency department overcrowding: understanding the factors to find corresponding solutions. J Pers Med 2022; 12: 279.
- 8. Pennington GA. Urgent care centers and what you need to know. Plast Reconstr Surg 2023; 152: 1139‐1143.
- 9. Hazel S, Suzanne M, Colin O, et al. What impact would reducing low‐acuity attendance have on emergency department length of stay? A discrete event simulation modelling study. Emerg Med J 2024; 41: 27‐33.
- 10. Australian Department of Health and Aged Care. About Medicare urgent care clinics. Updated 17 Mar 2025. https://www.health.gov.au/our‐work/medicare‐urgent‐care‐clinics/about‐medicare‐urgent‐care‐clinics (viewed Apr 2025).
- 11. Ramlakhan S, Mason S, O'Keeffe C, et al. Primary care services located with EDs: a review of effectiveness. Emerg Med J 2016; 33: 495‐503.
- 12. McCracken MA, Cooper IR, Hamilton MA, et al. Access to episodic primary care: a cross‐sectional comparison of walk‐in clinics and urgent primary care centers in British Columbia. Prim Health Care Res Dev 2023; 24: e66.
- 13. O'Malley AS, Samuel D, Bond AM, Carrier E. After‐hours care and its coordination with primary care in the US. J Gen Intern Med 2012; 27: 1406‐1415.
- 14. Nagel DA, Keeping‐Burke L, Shamputa IC. Concept analysis and proposed definition of community health center. J Prim Care Community Health 2021; 12: 21501327211046436.
- 15. Huibers L, Thijssen W, Koetsenruijter J, et al. GP cooperative and emergency department: an exploration of patient flows. J Eval Clin Pract 2013; 19: 243‐249.
- 16. Smits M, Huibers L, Oude Bos A, Giesen P. Patient satisfaction with out‐of‐hours GP cooperatives: a longitudinal study. Scand J Prim Health Care 2012; 30: 206‐213.
- 17. Domino ME. Unpacking the patient‐centered medical home. Health Serv Res 2021; 56: 350‐351.
- 18. GL, Powers BJ, Chatterjee R, et al. The patient centered medical home. A systematic review. Ann Intern Med 2013; 158: 169‐178.
- 19. Alemagno SA, Zyzanski SJ, Silko GJ. Urgent care centers: what does “urgent” really mean? Fam Pract Res J 1986; 6: 12‐21.
- 20. Arain M, Campbell MJ, Nicholl JP. Impact of a GP‐led walk‐in centre on NHS emergency departments. Emerg Med J 2015; 32: 295‐300.
- 21. Baughman DJ, Waheed A, Khan MN, Nicholson JM. Enhancing value‐based care with a walk‐in clinic: a primary care provider intervention to decrease low acuity emergency department overutilization. Cureus 2021; 13: e13284.
- 22. Colliers A, Remmen R, Streffer ML, et al. Implementation of a general practitioner cooperative adjacent to the emergency department of a hospital increases the caseload for the GPC but not for the emergency department. Acta Clin Belg 2017; 72: 49‐54.
- 23. Dolton P, Pathania V. Can increased primary care access reduce demand for emergency care? Evidence from England's 7‐day GP opening. J Health Econ 2016; 49: 193‐208.
- 24. Hsu RT, Lambert PC, Dixon‐Woods M, Kurinczuk JJ. Effect of NHS walk‐in centre on local primary healthcare services: before and after observational study. BMJ 2003; 326: 530.
- 25. Jones D, Carroll L, Frank L. After‐hours care in suburban Canada: influencing emergency department utilization. J Prim Care Community Health 2011; 2: 250‐254.
- 26. Maynard EJ, Dodge JS. Introducing a community health center at Mosgiel, New Zealand: effects on use of the hospital accident and emergency (A & E) department. Med Care 1983; 21: 379‐388.
- 27. Merritt B, Naamon E, Morris SA. The influence of an Urgent Care Center on the frequency of ED visits in an urban hospital setting. Am J Emerg Med 2000; 18: 123‐125.
- 28. Moore GT, Bernstein R, Bonanno RA. Effect of a neighborhood health center on hospital emergency room use. Med Care 1972; 10: 240‐247.
- 29. O'Keeffe N. The effect of a new general practice out‐of‐hours co‐operative on a county hospital accident and emergency department. Ir J Med Sci 2008; 177: 367‐370.
- 30. O'Kelly FD, Teljeur C, Carter I, Plunkett PK. Impact of a GP cooperative on lower acuity emergency department attendances. Emerg Med J 2010; 27: 770‐773.
- 31. Payne K, Dutton T, Weal K, et al. An after hours GP clinic in regional Australia: appropriateness of presentations and impact on local emergency department presentations. BMC Fam Pract 2017; 18: 86.
- 32. Pines JM, Keyes V, Van Hasselt M, McCall N. Emergency department and inpatient hospital use by Medicare beneficiaries in patient‐centered medical homes. Ann Emerg Med 2015; 65: 652‐660.
- 33. Salisbury C, Hollinghurst S, Montgomery A, et al. The impact of co‐located NHS walk‐in centres on emergency departments. Emerg Med J 2007; 24: 265‐269.
- 34. Van Uden CJT, Winkens RAG, Wesseling G, et al. The impact of a primary care physician cooperative on the caseload of an emergency department: the Maastricht integrated out‐of‐hours service. J Gen Intern Med 2005; 20: 612‐617.
- 35. Wackers EME, Stadhouders NW, Maessen MFH, et al. Association between acute care collaborations and health care utilization as compared to stand‐alone facilities in the Netherlands: a quasi‐experimental study. Eur J Emerg Med 2023; 30: 15‐20.
- 36. Buckley DJ, Curtis PW, McGirr JG. The effect of a general practice after‐hours clinic on emergency department presentations: a regression time series analysis. Med J Aust 2010; 192: 448‐451. https://www.mja.com.au/journal/2010/192/8/effect‐general‐practice‐after‐hours‐clinic‐emergency‐department‐presentations
- 37. Chalder M, Sharp D, Moore L, Salisbury C. Impact of NHS walk‐in centres on the workload of other local healthcare providers: time series analysis. BMJ 2003; 326: 532.
- 38. Hong M, Thind A, Zaric GS, Sarma S. Emergency department use following incentives to provide after‐hours primary care: a retrospective cohort study. CMAJ 2021; 193: E85‐E93.
- 39. Pacheco J, Cuadrado C, Martínez‐Gutiérrez MS. Urgent care centres reduce emergency department and primary care same‐day visits: a natural experiment. Health Policy Plan 2019; 34: 170‐177.
- 40. Philips H, Remmen R, Van Royen P, et al. What's the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care. BMC Health Serv Res 2010; 10: 222.
- 41. Rust G, Baltrus P, Ye J, Daniels E, et al. Presence of a community health center and uninsured emergency department visit rates in rural counties. J Rural Health 2009; 25: 8‐16.
- 42. van Uden CJT, Crebolder HFJM. Does setting up out of hours primary care cooperatives outside a hospital reduce demand for emergency care? Emerg Med J 2004; 21: 722‐723.
- 43. Whittaker W, Anselmi L, Kristensen SR, et al. Associations between extending access to primary care and emergency department visits: a difference‐in‐differences analysis. PLoS Med 2016; 13: e1002113.
- 44. Galloway K, Lambert P, Bow EJ, et al. Evaluation of the impact of the urgent cancer care clinic on emergency department visits, primary care clinician visits, and hospitalizations in Winnipeg, Manitoba. Curr Oncol 2023; 30: 6771‐6785.
- 45. Lippi Bruni M, Ugolini C, Verzulli R, Leucci AC. The impact of community health centers on inappropriate use of emergency services. Health Econ 2023; 32: 375‐394.
- 46. Devlin RA, Kpelitse KA, Li L, et al. After‐hours incentives and emergency department visits: evidence from Ontario. Can Public Policy 2020; 46: 253‐263.
- 47. Horwitz SM, Busch SH, Balestracci KMB, et al. Intensive intervention improves primary care follow‐up for uninsured emergency department patients. Acad Emerg Med 2005; 12: 647‐652.
- 48. Wright B, Potter AJ, Trivedi A. Federally qualified health center use among dual eligibles: rates of hospitalizations and emergency department visits. Health Aff (Millwood) 2015; 34: 1147‐1155.
- 49. Jones A, Bronskill SE, Schumacher C, et al. Effect of access to after‐hours primary care on the association between home nursing visits and same‐day emergency department use. Ann Fam Med 2020; 18: 406‐412.
- 50. Ablard S, O'Keeffe C, Ramlakhan S, Mason SM. Primary care services co‐located with Emergency Departments across a UK region: early views on their development. Emerg Med J 2017; 34: 672‐676.
- 51. Brown JB, Sangster LM, Ostbye T, et al. Walk‐in clinics: patient expectations and family physician availability. Fam Pract 2002; 19: 202‐206.
- 52. Greenfield G, Ignatowicz A, Gnani S, et al. Staff perceptions on patient motives for attending GP‐led urgent care centres in London: a qualitative study. BMJ Open 2016; 6: e007683.
- 53. Heutmekers M, Naaldenberg J, Mastebroek M, et al. Out‐of‐hours primary care for people with intellectual disabilities: interviews in general practice. Fam Pract 2022; 39: 106‐111.
- 54. Johansen IH, Carlsen B, Hunskaar S. Psychiatry out‐of‐hours: a focus group study of GPs’ experiences in Norwegian casualty clinics. BMC Health Serv Res 2011; 11: 132.
- 55. Keizer E, Maassen I, Smits M, et al. Reducing the use of out‐of‐hours primary care services: a survey among Dutch general practitioners. Eur J Gen Pract 2016; 22: 189‐195.
- 56. van Uden CJT, Nieman FHM, Voss GBWE, et al. General practitioners’ satisfaction with and attitudes to out‐of‐hours services. BMC Health Serv Res 2005; 5: 27.
- 57. Amiel C, Williams B, Ramzan F, et al. Reasons for attending an urban urgent care centre with minor illness: a questionnaire study. Emerg Med J 2014; 31: e71‐e75.
- 58. Egbunike JN, Shaw C, Porter A, et al. Streamline triage and manage user expectations: lessons from a qualitative study of GP out‐of‐hours services. Br J Gen Pract 2010; 60: e83‐e97.
- 59. Greene L, Lane R, Crotty M, et al. Evaluating a new emergency department avoidance service for older people: patient and relative experiences. Emerg Med J 2023; 40: 641‐645.
- 60. Hutchison B, Ostbye T, Barnsley J, et al; Ontario Walk‐In Clinic Study. Patient satisfaction and quality of care in walk‐in clinics, family practices and emergency departments: the Ontario walk‐in clinic study. CMAJ 2003; 168: 977‐983.
- 61. Jackson CJ, Dixon‐Woods M, Hsu R, Kurinczuk JJ. A qualitative study of choosing and using an NHS Walk‐in Centre. Fam Pract 2005; 22: 269‐274.
- 62. McKinley RK, Stevenson K, Adams S, Manku‐Scott TK. Meeting patient expectations of care: the major determinant of satisfaction with out‐of‐hours primary medical care? Fam Pract 2002; 19: 333‐338.
- 63. Rizos J, Anglin P, Grava‐Gubins I, Lazar C. Walk‐in clinics: implications for family practice. CMAJ 1990; 143: 740‐745.
- 64. Salisbury C. Postal survey of patients’ satisfaction with a general practice out of hours cooperative. BMJ 1997; 314: 1594‐1598.
- 65. Shipman C, Payne F, Hooper R, Dale J. Patient satisfaction with out‐of‐hours services; how do GP co‐operatives compare with deputizing and practice‐based arrangements? J Public Health Med 2000; 22: 149‐154.
- 66. Arain M, Baxter S, Nicholl JP. Perceptions of healthcare professionals and managers regarding the effectiveness of GP‐led walk‐in centres in the UK. BMJ Open 2015; 5: e008286.
- 67. Bury G, Janes D, Dowling J. General practice out‐of‐hours co‐operatives in Ireland‐emergency service or not? Ir J Med Sci 2005; 174: 47‐52.
- 68. Hallam L, Henthorne K. Cooperatives and their primary care emergency centres: organisation and impact. Combined report on seven case studies. Health Technol Assess 1999; 3: iii‐85.
- 69. Philips H, Mahr D, Remmen R, et al. Experience: the most critical factor in choosing after‐hours medical care. Qual Saf Health Care 2010; 19: e3.
- 70. Global Emergency Care Community of Practice. GECCoP meeting communique, 19 June 2023. https://acem.org.au/getmedia/7d016556‐2c38‐4ed1‐86bd‐6b4f1913f9d8/GECCoP‐Meeting‐Communique_19‐June‐2023 (viewed Sept 2024).
- 71. Morley C, Unwin M, Peterson GM, et al. Emergency department crowding: a systematic review of causes, consequences and solutions. PLoS One 2018; 13: e0203316.
- 72. Van Der Linden MC, Van Loon‐Van Gaalen M, Richards JR, et al. Effects of process changes on emergency department crowding in a changing world: an interrupted time‐series analysis. Int J Emerg Med 2023; 16: 6.
- 73. Butun A, Kafdag EE, Gunduz H, et al. Emergency department overcrowding: causes and solutions. Emerg Crit Care Med 2023; 3: 171‐176.
- 74. Nagree Y, Camarda VJ, Fatovich DM, et al. Quantifying the proportion of general practice and low‐acuity patients in the emergency department. Med J Aust 2013; 198: 612‐615. https://www.mja.com.au/journal/2013/198/11/quantifying‐proportion‐general‐practice‐and‐low‐acuity‐patients‐emergency
- 75. Morris T, Mason SM, Moulton C, O'Keeffe C. Calculating the proportion of avoidable attendances at UK emergency departments: analysis of the Royal College of Emergency Medicine's Sentinel Site Survey data. Emerg Med J 2018; 35: 114‐119.
- 76. Crawford J, Cooper S, Cant R, DeSouza R. The impact of walk‐in centres and GP co‐operatives on emergency department presentations: a systematic review of the literature. Int Emerg Nurs 2017; 34: 36‐42.
- 77. Chernin G, Gal‐Oz A, Schwartz IF, et al. Care of undocumented‐uninsured immigrants in a large urban dialysis unit. BMC Nephrol 2012; 13: 112.
- 78. Institute of Medicine Committee on the Consequences of Uninsurance. A shared destiny: community effects of uninsurance. Washington: National Academies Press, 2003.
- 79. Adams EJ, Morris L, Marshall G, et al. Effectiveness and implementation of interventions for health promotion in urgent and emergency care settings: an umbrella review. BMC Emerg Med 2023; 23: 41.
- 80. Adie JW, Graham W, O'Donnell R, Wallis M. Patient presentations to an after‐hours general practice, an urgent care clinic and an emergency department on Sundays: a comparative, observational study. J Health Organ Manag 2023; 37: 96‐115.
- 81. Youens D, Robinson S, Doust J, et al. Associations between regular GP contact, diabetes monitoring and glucose control: an observational study using general practice data. BMJ Open 2021; 11: e051796.
- 82. Jackson C, Ball L. Continuity of care: vital, but how do we measure and promote it? Aust J Gen Pract 2018; 47: 662‐664.
- 83. Willson KA, Lim D, Toloo GS, et al. Potential role of general practice in reducing emergency department demand: a qualitative study. Emerg Med Australas 2022; 34: 717‐724.
- 84. Australian Department of Health and Aged Care. Operational guidance for urgent care clinics: endorsed by the Urgent Care Clinics Senior Officials Advisory Group. 14 Nov 2022. https://www.health.gov.au/sites/default/files/2024‐03/medicare‐ucc‐operational‐guidance.pdf (viewed Apr 2025).
- 85. International Federation for Emergency Medicine. Global campaign against ED over‐crowding. Undated. https://www.ifem.cc/global_campaign_against_ed_over_crowding (viewed Mar 2024).
- 86. Organisation for Economic Co‐operation and Development. The future of health systems. Undated. https://www.oecd.org/en/topics/policy‐issues/the‐future‐of‐health‐systems.html (viewed Sept 2024).
Abstract
Objectives: To identify published studies that examined the impact of urgent care centres on the numbers of presentations to emergency departments (EDs), or explored the experiences and views of patients and practitioners regarding urgent care centres as alternative sources of health care and advice.
Study design: Scoping review of qualitative and quantitative studies published to 28 August 2024.
Data sources: MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, and CINAHL databases; grey literature searches.
Data synthesis: Of 2698 potentially relevant publications, 51 met our inclusion criteria (30 quantitative studies; 21 qualitative studies). Urgent care centres of various types were led by general practitioners in 41 of 51 studies, primarily managed people with non‐urgent conditions or minor illnesses in 34 studies and non‐emergency but urgent conditions in eight, and nine of the 22 studies that discussed funding indicated that access to the centres was free of charge. The effect of urgent care centres on ED presentation numbers was mixed; all seven studies of after‐hours clinics, one of two studies of 24‐hour clinics, and four of five studies of walk‐in centres reported reduced ED visit numbers; in eleven studies that reported effects on hospital admissions from the ED, they were lower in seven (studies of an urgent cancer care centre, four community health centres, and a general practitioner cooperative). Patient satisfaction with urgent care centres is generally as high as with other primary care services; they preferred them to EDs, and preferred personal triage to telephone triage. Reasons for people choosing urgent care centres included easier access and the unavailability of doctors or appointments elsewhere. Clinicians reported increased workload, mixed experiences with the coordination of care, concerns about unregistered or undocumented people using the services, and protocol confusion, particularly with respect to triage. Continuity of care was a concern for both clinicians and patients.
Conclusions: Urgent care centres, especially walk‐in and after‐hours clinics, can help reduce the number of ED presentations and reduce health care costs. Patient satisfaction with such clinics is high, but public health education could guide people to appropriate care for non‐urgent health problems. Training in the management of conditions frequently seen in urgent care centres is needed to ensure consistent, effective care.