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General practitioners providing non-urgent care in emergency department: a natural experiment

Uthman, Olalekan A, Walker, Clare, Sudakshina, Lahiri, Jenkinson, David, Adekanmbi, Victor, Robertson, Wendy and Clarke, Aileen 2018. General practitioners providing non-urgent care in emergency department: a natural experiment. BMJ Open 8 (5) , e019736. 10.1136/bmjopen-2017-019736

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Objective To examine whether care provided by general practitioners (GPs) to non-urgent patients in the emergency department differs significantly from care provided by usual accident and emergency (A&E) staff in terms of process outcomes and A&E clinical quality indicators. Design Propensity score matched cohort study. Setting GPs in A&E colocated within the University Hospitals Coventry and Warwickshire NHS Trust between May 2015 and March 2016. Participants Non-urgent attendances visits to the A&E department. Main outcomes Process outcomes (any investigation, any blood investigation, any radiological investigation, any intervention, admission and referrals) and A&E clinical indicators (spent 4 hours plus, left without being seen and 7-day reattendance). Results A total of 5426 patients seen by GPs in A&E were matched with 10 852 patients seen by emergency physicians (ratio 1:2). Compared with standard care in A&E, GPs in A&E significantly: admitted fewer patients (risk ratio (RR) 0.28, 95% CI 0.25 to 0.31), referred fewer patients to other specialists (RR 0.31, 95% CI 0.24 to 0.40), ordered fewer radiological investigations (RR 0.38, 95% CI 0.34 to 0.42), ordered fewer blood tests (0.57, 95% CI 0.52 to 0.61) and ordered fewer investigations (0.93, 95% CI 0.90 to 0.96). However, they intervened more, offered more primary care follow-up (RR 1.78, 95% CI 1.67 to 1.89) and referred more patients to outpatient and other A&E clinics (RR 2.29, 95% CI 2.10 to 2.49). Patients seen by GPs in A&E were on average less likely to spend 4 hours plus in A&E (RR 0.37, 95% CI 0.30 to 0.45) compared with standard care in A&E. There was no difference in reattendance after 7 days (RR 0.96, 95% CI 0.84 to 1.09). Conclusion GPs in A&E tended to manage self-reporting minor cases with fewer resources than standard care in A&E, without increasing reattendance rates.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Publisher: BMJ Publishing Group: Open Access / BMJ Journals
ISSN: 2044-6055
Funders: Coventry�Rugby GP Alliance
Date of First Compliant Deposit: 11 May 2018
Date of Acceptance: 6 April 2018
Last Modified: 30 May 2018 13:00

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