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Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation

Freya Davies Orcid Logo, Michelle Edwards Orcid Logo, Delyth Price Orcid Logo, Pippa Anderson, Andrew Carson-Stevens Orcid Logo, Mazhar Choudhry Orcid Logo, Matthew Cooke Orcid Logo, Jeremy Dale Orcid Logo, Liam Donaldson Orcid Logo, Bridie Evans Orcid Logo, Barbara Harrington, Shaun Harris Orcid Logo, Julie Hepburn, Peter Hibbert Orcid Logo, Thomas Hughes Orcid Logo, Faris Hussain Orcid Logo, Saiful Islam Orcid Logo, Rhys Pockett Orcid Logo, Alison Porter Orcid Logo, Aloysius Niroshan Siriwardena Orcid Logo, Helen Snooks Orcid Logo, Alan Watkins Orcid Logo, Adrian Edwards Orcid Logo, Alison Cooper Orcid Logo

Health and Social Care Delivery Research, Volume: 12, Issue: 10, Pages: 1 - 152

Swansea University Authors: Pippa Anderson, Bridie Evans Orcid Logo, Shaun Harris Orcid Logo, Saiful Islam Orcid Logo, Rhys Pockett Orcid Logo, Alison Porter Orcid Logo, Helen Snooks Orcid Logo, Alan Watkins Orcid Logo

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DOI (Published version): 10.3310/jwqz5348

Abstract

BackgroundEmergency healthcare services are under intense pressure to meet increasing patient demands. Many patients presenting to emergency departments could be managed by general practitioners in general practitioner–emergency department service models.ObjectivesTo evaluate the effectiveness, safe...

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Published in: Health and Social Care Delivery Research
ISSN: 2755-0079
Published: National Institute for Health and Care Research 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa66228
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Abstract: BackgroundEmergency healthcare services are under intense pressure to meet increasing patient demands. Many patients presenting to emergency departments could be managed by general practitioners in general practitioner–emergency department service models.ObjectivesTo evaluate the effectiveness, safety, patient experience and system implications of the different general practitioner–emergency department models.DesignMixed-methods realist evaluation.MethodsPhase 1 (2017–8), to understand current practice: rapid realist literature review, national survey and follow-up key informant interviews, national stakeholder event and safety data analysis. Phase 2 (2018–21), to collect and analyse qualitative (observations, interviews) and quantitative data (time series analysis); cost–consequences analysis of routine data; and case site data for ‘marker condition’ analysis from a purposive sample of 13 case sites in England and Wales. Phase 3 (2021–2), to conduct mixed-methods analysis for programme theory and toolkit development.ResultsGeneral practitioners commonly work in emergency departments, but delivery models vary widely in terms of the scope of the general practitioner role and the scale of the general practitioner service. We developed a taxonomy to describe general practitioner–emergency department service models (Integrated with the emergency department service, Parallel within the emergency department, Outside the emergency department on the hospital site) and present a programme theory as principal output of the study to describe how these service models were observed to operate. Routine data were of variable quality, limiting our analysis. Time series analysis demonstrated trends across intervention sites for: increased time spent in the emergency department; increased emergency department attendances and reattendances; and mixed results for hospital admissions. Evidence on patient experience was limited but broadly supportive; we identified department-level processes to optimise the safety of general practitioner–emergency department models.LimitationsThe quality, heterogeneity and extent of routine emergency department data collection during the study period limited the conclusions. Recruitment was limited by criteria for case sites (time series requirements) and individual patients (with ‘marker conditions’). Pandemic and other pressures limited data collection for marker condition analysis. Data collected and analysed were pre pandemic; new approaches such as ‘telephone first’ and their relevance to our findings remains unexplored.ConclusionFindings suggest that general practitioner–emergency department service models do not meet the aim of reducing the overall emergency department waiting times and improving patient flow with limited evidence of cost savings. Qualitative data indicated that general practitioners were often valued as members of the wider emergency department team. We have developed a toolkit, based on our findings, to provide guidance for implementing and delivering general practitioner–emergency department services.
College: Faculty of Medicine, Health and Life Sciences
Funders: NIHR Health and Social Care Delivery Research (HSDR) Programme
Issue: 10
Start Page: 1
End Page: 152