Hospital-integrated general practice: a promising way to manage walk-in patients in emergency departments

2013 ◽  
Vol 20 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Mathyas Wang ◽  
Stefanie Wild ◽  
Gabriela Hilfiker ◽  
Corinne Chmiel ◽  
Patrick Sidler ◽  
...  
Keyword(s):  
General Practice ◽  
Emergency Departments

scholarly journals Drivers of ‘clinically unnecessary’ use of emergency and urgent care: the DEUCE mixed-methods study

2020 ◽  
Vol 8 (15) ◽  
pp. 1-256
Author(s):  
Alicia O’Cathain ◽  
Emma Knowles ◽  
Jaqui Long ◽  
Janice Connell ◽  
Lindsey Bishop-Edwards ◽  
...  
Keyword(s):  
General Practice ◽  
Mixed Methods ◽  
General Practitioner ◽  
Health Service ◽  
Health Services ◽  
Focus Groups ◽  
Emergency Departments ◽  
Help Seeking ◽  
Mixed Methods Study ◽  
Coping Capacity

Background There is widespread concern about the pressure on emergency and urgent services in the UK, particularly emergency ambulances, emergency departments and same-day general practitioner appointments. A mismatch between supply and demand has led to interest in what can be termed ‘clinically unnecessary’ use of services. This is defined by the research team in this study as ‘patients attending services with problems that are classified as suitable for treatment by a lower urgency service or self-care’. This is a challenging issue to consider because patients may face difficulties when deciding the best action to take, and different staff may make different judgements about what constitutes a legitimate reason for service use. Objectives To identify the drivers of ‘clinically unnecessary’ use of emergency ambulances, emergency departments and same-day general practitioner appointments from patient and population perspectives. Design This was a sequential mixed-methods study with three components: a realist review; qualitative interviews (n = 48) and focus groups (n = 3) with patients considered ‘clinically unnecessary’ users of these services, focusing on parents of young children, young adults and people in areas of social deprivation; and a population survey (n = 2906) to explore attitudes towards seeking care for unexpected, non-life-threatening health problems and to identify the characteristics of someone with a tendency for ‘clinically unnecessary’ help-seeking. Results From the results of the three study components, we found that multiple, interacting drivers influenced individuals’ decision-making. Drivers could be grouped into symptom related, patient related and health service related. Symptom-related drivers were anxiety or need for reassurance, which were caused by uncertainty about the meaning or seriousness of symptoms; concern about the impact of symptoms on daily activities/functioning; and a need for immediate relief of intolerable symptoms, particularly pain. Patient-related drivers were reduced coping capacity as a result of illness, stress or limited resources; fear of consequences when responsible for another person’s health, particularly a child; and the influence of social networks. Health service-related drivers were perceptions or previous experiences of services, particularly the attractions of emergency departments; a lack of timely access to an appropriate general practitioner appointment; and compliance with health service staff’s advice. Limitations Difficulty recruiting patients who had used the ambulance service to the interviews and focus groups meant that we were not able to add as much as we had anticipated to the limited evidence base regarding this service. Conclusions Patients use emergency ambulances, emergency departments and same-day general practitioner appointments when they may not need the level of clinical care provided by these services for a multitude of inter-related reasons that sometimes differ by population subgroup. Some of these reasons relate to health services, in terms of difficulty accessing general practice leading to use of emergency departments, and to population-learnt behaviour concerning the positive attributes of emergency departments, rather than to patient characteristics. Social circumstances, such as complex and stressful lives, influence help-seeking for all three services. Demand may be ‘clinically unnecessary’ but completely understandable when service accessibility and patients’ social circumstances are considered. Future work There is a need to evaluate interventions, including changing service configuration, strengthening general practice and addressing the stressors that have an impact on people’s coping capacity. Different subgroups may require different interventions. Study registration This study is registered as PROSPERO CRD42017056273. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 15. See the NIHR Journals Library website for further project information.

Il Symptom Questionnaire come strumento di screening nei contesti sanitari di base

1994 ◽  
Vol 3 (1) ◽  
pp. 31-37 ◽  
Author(s):  
Paola Rucci ◽  
Piero de Marco ◽  
Raffaella Bivi
Keyword(s):  
General Practice ◽  
Emergency Departments ◽  
Roc Analysis ◽  
High Sensitivity ◽  
Significant Drop ◽  
Cross Sectional ◽  
Hospital Medical ◽  
Symptom Questionnaire ◽  
Medical Wards ◽  
First Interview

SummaryObjective. - To test by means of ROC analysis the performance of the Symptom Questionnaire (SQ) of Kellner and Fava against an interview designed for making DSM-III diagnoses in 517 subjects. To analyse the trend of SQ scores at 3 months, 1 year and 2 years after the first interview in a sample of 112 persons. Design. - Cross-sectional and longitudinal analysis of the distributions of SQ scores in DSM-III cases and in non-cases. Setting. - General practice, hospital medical wards and emergency departments of Regione Emilia Romagna. Main outcome measures. - Symptom Questionnaire, Bech Mini-compendium to formulate DSM-III diagnoses. Results. - The SQ reached high sensitivity and specificity levels (80%, 76% in general practice, 86%, 74% in hospital medical wards, 83%, 85% in emergency departments with the cut-off scores of 24, 24 and 26, respectively). SQ scores show a similar trend in cases and in non-cases, with a significant drop at three months. Conclusions. - The SQ seems to be an adequate screening tool in the above-mentioned settings, but its length and the assistance sometimes needed during the compilation make its use in the emergency departments problematic.

scholarly journals Why do patients seek primary medical care in emergency departments? An ethnographic exploration of access to general practice

BMJ Open ◽  
2017 ◽  
Vol 7 (4) ◽  
pp. e013816 ◽  
Author(s):  
Fiona MacKichan ◽  
Emer Brangan ◽  
Lesley Wye ◽  
Kath Checkland ◽  
Daniel Lasserson ◽  
...  
Keyword(s):  
General Practice ◽  
Medical Care ◽  
Emergency Departments ◽  
Primary Medical Care

General practice is just as pressured as emergency departments, MPs hear

BMJ ◽  
2013 ◽  
Vol 346 (jun05 1) ◽  
pp. f3672-f3672
Author(s):  
A. O'Dowd
Keyword(s):  
General Practice ◽  
Emergency Departments

scholarly journals Brief Research Note: A Comparison of the Provision of Counselling and Advice to Primary Care Patients in Emergency Departments and a General Practice Casualty Department

2002 ◽  
Vol 8 (1) ◽  
pp. 91 ◽  
Author(s):  
Patrick Bolton ◽  
Michael Mira
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
General Practice ◽  
General Practitioner ◽  
Emergency Departments ◽  
Adverse Outcome ◽  
Triage Nurse ◽  
Ambulatory Patients ◽  
Primary Care Patients ◽  
Research Officer

Data were collected from clinicians at the time of consultation about the care that they provided in 12,813 encounters in a general practitioner (GP) staffed casualty department and 719 primary care encounters in two emergency departments (Bolton, 1999). Data were collected by the GPs themselves in general practice, and by a research officer located in the emergency departments. Patients seen in the emergency department were ambulatory patients whom the triage nurse assessed would not suffer an adverse outcome if they had to wait an hour or longer for care. Comparison of these two patient populations established that they were similar in terms of age, gender, ethnicity, and reason for encounter.

Rural emergency departments supplement general practice care

2015 ◽  
Vol 202 (1) ◽  
pp. 17-18 ◽  
Author(s):  
Penny L Allen ◽  
Colleen Cheek ◽  
Marielle Ruigrok
Keyword(s):  
General Practice ◽  
Emergency Departments ◽  
General Practice Care ◽  
Practice Care
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