Uthman, Olalekan A., Walker, Clare, Lahiri, Sudakshina, Jenkinson, David J., Adekanmbi, Victor, Robertson, Wendy and Clarke, Aileen (2018) General practitioners providing non-urgent care in emergency department : a natural experiment. BMJ Open, 8 . e019736. doi:10.1136/bmjopen-2017-019736 ISSN 2044-6055.

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Abstract

Objective: To examine whether care provided by general practitioners (GPs) to non-urgent patients in the emergency department (ED) 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 co-located within the University Hospitals Coventry and Warwickshire NHS Trust (UHCW) 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 seven-day re-attendance).

Results: A total of 5,426 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% confidence interval [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 out-patient 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 four 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 re-attendance after seven 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 re-attendance rates.

Item Type:	Journal Article
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Journal or Publication Title:	BMJ Open
Publisher:	BMJ
ISSN:	2044-6055
Official Date:	10 May 2018
Dates:	Date Event 10 May 2018 Published 6 April 2018 Accepted
Volume:	8
Article Number:	e019736
DOI:	10.1136/bmjopen-2017-019736
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	10 April 2018
Date of first compliant Open Access:	21 February 2019
Related URLs:	Publisher

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