Changes in the Patterns of Emergency Ambulance Care During a Primary Care Model Programme in Hungary

Background: Hungary operated a public health-focused primary care model programme with expanded preventive and community-based services between 2013 and 2017 in four disadvantaged regions. This study aimed at assessing the association of this programme in one region with the patterns of emergency ambulance care before (2012) the programme and 3 years later when all services were available (2016). Methods: Patients in the selected region who received emergency ambulance care in the hospital catchment area were included. De-identified demographic data, reason for emergency service, on-site and hospital diagnosis, and treatment outcomes were entered into an electronic database from paper-based records. Diagnoses were assigned separate codes at GBD 1 and 3 levels. Results: The proportion of patients in emergency ambulance care showed a significant, 0.85% increase (p = 0.013) from 2012 to 2016. The proportion of female/male patients was roughly equal, but males needed emergency ambulance care significantly, 7 years younger than females in both years. Among patients with GPs in the model programme, 3.41% fewer needed emergency ambulance care due to non-communicable diseases, and 1.98% fewer were referred to other institutions from the hospital A&ED compared to those whose GPs did not participate (p < 0.001 for all). Conclusions: Utilisation of emergency ambulance services rose in the region in line with global trends suggesting that expanding primary care services alone may not be sufficient to reduce demand for emergency ambulance services. Further research is warranted to identify individual and systemic factors with major influence on emergency care use, including patient-level differences in the use of acute and preventive primary care services, and the availability of primary care after work hours.