scholarly journals Emergency medicine and "acute" general practice: comparing apples with 0ranges

2000 ◽  
Vol 23 (2) ◽  
pp. 152 ◽  
Author(s):  
Sue Ieraci ◽  
Paul Cunningham ◽  
Janet Talbot-Stern
Keyword(s):  
Emergency Medicine ◽  
General Practice ◽  
Cost Effectiveness ◽  
Service Provision ◽  
Patient Population ◽  
Waiting Times ◽  
Service Planning ◽  
Precise Analysis ◽  
Gp Services ◽  
After Hours

Emergency Departments (EDs) operate at the interface between the inpatient and ambulatory sectorsof health care. Because of shared funding between the Commonwealth and States for ambulatory care,there has been intense focus on the ED patient population, and the potential to shift the locus of carefor non-inpatients.One of the frequently cited models for the provision of after-hours GP services is the Balmain GeneralPractice Casualty (GPC). This paper analyses the GPC model, looking in detail at casemix, clinicalquality, waiting times and cost-effectiveness. It is argued that the services provided and the casemix ofthe patient population of GPC and EDs are distinctly different. Cost-effectiveness for GPC has notbeen objectively established.Health service planning should recognise the distinct but complementary roles of general practice andemergency medicine. Evaluation of alternative models of service provision should critically examine theavailable evidence, and comparisons should be based on a precise analysis of equivalent services.

scholarly journals After-hours general practice clinics are unlikely to reduce low acuity patient attendances to metropolitan Perth emergency departments

2004 ◽  
Vol 28 (3) ◽  
pp. 285 ◽  
Author(s):  
Yusuf Nagree ◽  
Tor N O Ercleve ◽  
Peter C Sprivulis
Keyword(s):  
General Practice ◽  
Emergency Departments ◽  
Attendance Rates ◽  
Discharge Rates ◽  
Gp Services ◽  
After Hours ◽  
The Difference

Objective: To model the effectiveness of afterhours general practice (GP) in reducing metropolitan Perth emergency departments? (ED) low acuity patient (LAP) attendances and costs. Methods: We estimated LAP attendances by comparison of the product of (A) the difference between self-referred and GP-referred ED discharge rates and (B) total self-referred attendances (LAP attendances = A - B). We then compared after-hours ED LAP attendance rates and costs with inner metropolitan 'working-week' ED LAP attendance rates and costs, when GP services are maximally available. Results: Working-week LAP attendances comprised 8.2% (95% CI, 8.0%?8.4%) of inner metropolitan ED attendances. Excess weekend and evening LAP attendances were estimated to comprise 16.5% (95%CI, 15.9%?17.0%) and 4.5% (95%CI, 4.1%?4.9%) of outer and inner metropolitan ED attendances respectively and totalled less than 3.0% of ED costs. Conclusions: Low acuity patients form a relatively constant, inexpensive proportion of ED workloads. After-hours GP LAP services are unlikely to significantly reduce ED attendances or costs.

Accessing Primary Health Care: A Community Survey of Issues regarding General Practice and Emergency Department Services in an Outer Metropolitan Area

2006 ◽  
Vol 12 (3) ◽  
pp. 78 ◽  
Author(s):  
AJ McGaw ◽  
P Jayasuriya ◽  
C Bulsara ◽  
S C Thompson
Keyword(s):  
General Practice ◽  
After Hours Care ◽  
Gp Services ◽  
After Hours ◽  
Appointment Availability ◽  
Gp Visits ◽  
Quota Sampling ◽  
Respiratory Conditions ◽  
Financial Issues ◽  
Specific Health

This survey aimed to identify views of residents of an outer metropolitan location towards general practice (GP) services, after-hours care and their use of emergency departments (ED). Four hundred respondents were selected randomly using quota sampling and interviewed by telephone. Respondents wanted a GP who was "easy to talk to", who listened and was interested in them, competent, straightforward and thorough. Of those who were dissatisfied, the main concerns were GPs' unwillingness to listen to the patient and rushing the consultation. GP visits occurred for specific health problems - most commonly fever, tiredness and respiratory conditions. Preventive advice regarding health and lifestyle issues was not mentioned as a reason for attending GPs. Appointment availability and financial issues impeded access to GPs. Most people who used an ED did so because of the unavailability of GP services, showing that access block starts in general practice, with the severity of their illness/injury being the second major reason.

scholarly journals GP services in Australia: presentation profiles during usual practice hours and after-hours periods

2020 ◽  
Vol 26 (2) ◽  
pp. 117
Author(s):  
Jannah Baker ◽  
Helena Britt ◽  
Christopher Harrison
Keyword(s):  
Patient Characteristics ◽  
Service Planning ◽  
Cross Sectional ◽  
Usual Practice ◽  
Management Actions ◽  
Representative Study ◽  
After Hours Care ◽  
Gp Services ◽  
After Hours ◽  
Reasons For Encounter

After-hours general practitioner (GP) services can reduce emergency department demand, which is currently increasing in Australia. Understanding GP after-hours care may assist in service planning. From April 2014 to March 2015, 986 GPs recorded 38275 consultations with start and finish times in the Bettering the Evaluation and Care of Health (BEACH) study, a national, cross-sectional, representative study of GP activity. GP and patient characteristics and the content of encounters in usual-hours and after-hours were compared. Significantly more after-hours than usual-hours encounters were with: GPs aged 60+ years; in metropolitan practices; and practices with 10+ GPs. Patients seen after-hours were more often: male; aged 15–64 years; new to practice; and less likely to hold a Commonwealth Concession Card. They were more likely to be prescribed antibiotics and less likely to: have chronic problems managed; be referred; receive psycholeptic or psychoanaleptic prescription; and undergo a procedure. Throat symptoms, fever and injury were more common reasons for encounter, while infections and injury were more frequently managed problems after-hours. The patient mix, GP characteristics, problems managed and management actions in after-hours care differ from those in usual-hours care in Australia. This greater understanding of after-hours care is the first step to informed resource allocation to improve the delivery of after-hours primary care.

The cost-effectiveness of one-time opportunistic screening for atrial fibrillation in different age cohorts of inhabitants in Denmark aged 65 years and above: a Markov modelled analysis

2020 ◽  
Author(s):  
Lucca Katrine Sciera ◽  
Lars Frost ◽  
Lars Dybro ◽  
Peter Bo Poulsen
Keyword(s):  
Atrial Fibrillation ◽  
General Practice ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Population Data ◽  
National Registry ◽  
Opportunistic Screening ◽  
Age Cohorts ◽  
Life Years ◽  
The Cost

Abstract Aims The objective was to evaluate the cost-effectiveness of one-time opportunistic screening for atrial fibrillation (AF) in general practice in citizens aged ≥65 years in Denmark compared to a no-screening alternative following current Danish practice. Methods and results A decision tree and a Markov model were designed to simulate costs and quality-adjusted life years (QALYs) in a hypothetical cohort of citizens aged ≥65 years equivalent to the Danish population (1 M citizens) over the course of 19 years, using a healthcare and societal perspective. Share of detected AF patients following opportunistic screening was retrieved from a recent Danish screening study, whereas the risk stroke and bleedings in AF patients were based on population data from national registries and their associated costs was obtained from published national registry studies. The present study showed that one-time opportunistic screening for AF was more costly, but also more effective compared to a no-screening alternative. The analysis predicts that one-time opportunistic screening of all Danes aged ≥65 years potentially can identify an additional 10 300 AF patients and prevent 856 strokes in the period considered. The incremental cost of such a screening programme is €56.4 M, with a total gain of 6000 QALYs, resulting in an incremental cost-effectiveness ratio of €9400 per QALY gained. Conclusion Opportunistic screening in general practice in citizens aged ≥65 years in Denmark is cost-effective compared to a willingness-to-pay threshold of €22 000. The study and its findings support a potential implementation of opportunistic screening for AF at the general practitioner level in Denmark.

scholarly journals Effectiveness and cost-effectiveness of implementing HIV testing in primary care in East London: protocol for an interrupted time series analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018163 ◽  
Author(s):  
Werner Leber ◽  
Lee Beresford ◽  
Claire Nightingale ◽  
Estela Capelas Barbosa ◽  
Stephen Morris ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
General Practice ◽  
Cost Effectiveness ◽  
Hiv Testing ◽  
Cost Effective ◽  
Interrupted Time Series ◽  
Rapid Hiv Testing ◽  
Post Trial ◽  
Implementation Programme

IntroductionHIV remains underdiagnosed. Guidelines recommend routine HIV testing in primary care, but evidence on implementing testing is lacking. In a previous study, the Rapid HIV Assessment 2 (RHIVA2) cluster randomised controlled trial, we showed that providing training and rapid point-of-care HIV testing at general practice registration (RHIVA2 intervention) in Hackney led to cost-effective, increased and earlier diagnosis of HIV. However, interventions effective in a trial context may be less so when implemented in routine practice. We describe the protocol for an MRC phase IV implementation programme, evaluating the impact of rolling out the RHIVA2 intervention in a post-trial setting. We will use a longitudinal study to examine if the post-trial implementation in Hackney practices is effective and cost-effective, and a cross-sectional study to compare Hackney with two adjacent boroughs providing usual primary care (Newham) and an enhanced service promoting HIV testing in primary care (Tower Hamlets).Methods and analysisService evaluation using interrupted time series and cost-effectiveness analyses. We will include all general practices in three contiguous high HIV prevalence East London boroughs. All adults aged 16 and above registered with the practices will be included. The interventions to be examined are: a post-trial RHIVA2 implementation programme (including practice-based education and training, external quality assurance, incentive payments for rapid HIV testing and incorporation of rapid HIV testing in the sexual health Local Enhanced Service) in Hackney; the general practice sexual health Network Improved Service in Tower Hamlets and usual care in Newham. Coprimary outcomes are rates of HIV testing and new HIV diagnoses.Ethics and disseminationThe chair of the Camden and Islington NHS Research Ethics Committee, London, has endorsed this programme as an evaluation of routine care. Study results will be published in peer-reviewed journals and reported to commissioners.

Parents' Time Is Worth Money

PEDIATRICS ◽  
1983 ◽  
Vol 71 (3) ◽  
pp. 466-466
Author(s):  
DOUGLAS RICHARDSON
Keyword(s):  
Intensive Care ◽  
Cost Effectiveness ◽  
Economic Analysis ◽  
Bronchopulmonary Dysplasia ◽  
Neonatal Intensive Care ◽  
Waiting Times ◽  
Opportunity Costs ◽  
Home Management ◽  
Tacit Assumption ◽  
The Cost

To the Editor.— I was delighted to see Donn's letter about the cost effectiveness of home management of bronchopulmonary dysplasia.1 Such contributions are vital in helping to curb the rapidly rising costs of neonatal intensive care. However, his economic analysis is flawed. By tacit assumption, he omits any consideration of the opportunity costs to the parents. To omit this presumes that the parents' time is worth little or nothing, as we often seem to indicate by the long patient waiting times in our offices.

scholarly journals Cost-effectiveness of habit-based advice for weight control versus usual care in general practice in the Ten Top Tips (10TT) trial: economic evaluation based on a randomised controlled trial

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e017511 ◽  
Author(s):  
Nishma Patel ◽  
Rebecca J Beeken ◽  
Baptiste Leurent ◽  
Rumana Z Omar ◽  
Irwin Nazareth ◽  
...  
Keyword(s):  
General Practice ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Randomised Controlled Trial ◽  
Health Service ◽  
Usual Care ◽  
Controlled Trial ◽  
Cost Effective ◽  
The Mean ◽  
Randomised Controlled

ObjectiveTen Top Tips (10TT) is a primary care-led behavioural intervention which aims to help adults reduce and manage their weight by following 10 weight loss tips. The intervention promotes habit formation to encourage long-term behavioural changes. The aim of this study was to estimate the cost-effectiveness of 10TT in general practice from the perspective of the UK National Health Service.DesignAn economic evaluation was conducted alongside an individually randomised controlled trial.Setting14 general practitioner practices in England.ParticipantsAll patients were aged ≥18 years, with body mass index ≥30 kg/m2. A total of 537 patients were recruited; 270 received the usual care offered by their practices and 267 received the 10TT intervention.Outcomes measuresHealth service use and quality-adjusted life years (QALYs) were measured over 2 years. Analysis was conducted in terms of incremental net monetary benefits (NMBs), using non-parametric bootstrapping and multiple imputation.ResultsOver a 2-year time horizon, the mean costs and QALYs per patient in the 10TT group were £1889 (95% CI £1522 to £2566) and 1.51 (95% CI 1.44 to 1.58). The mean costs and QALYs for usual care were £1925 (95% CI £1599 to £2251) and 1.51 (95% CI 1.45 to 1.57), respectively. This generated a mean cost difference of −£36 (95% CI −£512 to £441) and a mean QALY difference of 0.001 (95% CI −0.080 to 0.082). The incremental NMB for 10TT versus usual care was £49 (95% CI −£1709 to £1800) at a maximum willingness to pay for a QALY of £20 000. 10TT had a 52% probability of being cost-effective at this threshold.ConclusionsCosts and QALYs for 10TT were not significantly different from usual care and therefore 10TT is as cost-effective as usual care. There was no evidence to recommend nor advice against offering 10TT to obese patients in general practices based on cost-effectiveness considerations.Trial registration numberISRCTN16347068; Post-results.

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