scholarly journals 207 Patients’motivations and expectations when seeking urgent care at emergency departments and acceptability of primary care streaming: a realist study

2020 ◽  
Vol 37 (12) ◽  
pp. 832.1-832
Author(s):  
Michelle Edwards ◽  
Delyth Price ◽  
Julie Hepburn ◽  
Barbara Harrington ◽  
Bridie Evans ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Departments ◽  
Waiting Times ◽  
Urgent Care ◽  
Initial Assessment ◽  
Primary Care Clinician ◽  
Care Needs ◽  
Care Services ◽  
Primary Care Services ◽  
Past Experiences

Aims/Objectives/BackgroundWe aim to explain the contexts and mechanisms that influence patients’ motivations and expectations when accessing urgent care at an ED and their acceptability of being streamed to a primary care clinician working in or alongside the ED. Recent healthcare policy has encouraged the implementation of primary care services in or alongside emergency departments whereby patients with low acuity illness are streamed to a primary care clinician after a brief initial assessment. Our findings describe patients’ motivations, expectations, and acceptability of primary care streaming and their level of satisfaction.Methods/DesignWe recruited 24 patients to be interviewed after visiting an emergency department for one of five low acuity complaints. 12 patients were streamed to ED clinicians and 11 were streamed to primary care clinicians. We carried out semi-structured realist style interviews by telephone and carried out a realist analysis to create theories to explain motivations to attend, acceptability of streaming and satisfaction with care.Results/ConclusionsMotivations for attending the ED included patients’ perception of their complaint as an emergency which needed immediate treatment, and previous experience of receiving care at the ED. Acceptability of primary care streaming was related to patients’ past experiences accessing primary care services, their trust in initial assessment processes and their expectation to be seen by ‘expert clinicians’ on the ‘same day’. When patients’ expectations of waiting times, level of investigations and general quality of care were met or exceeded, they reported acceptability to being streamed to a primary care clinician and were satisfied with their care. Understanding why patients attend the ED for urgent care needs and their experience of primary care streaming is essential to addressing increasing ED demand and improving efficiency.

PP18 Is there provider induced demand at emergency departments with primary care services? Patient, local and wider system factors described to influence demand for primary care in emergency departments: realist evaluation

2021 ◽  
Vol 38 (9) ◽  
pp. A8.2-A8
Author(s):  
Michelle Edwards ◽  
Alison Cooper ◽  
Andrew Carson Stevens ◽  
Adrian Edwards ◽  
Thomas Hughes ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Departments ◽  
Realist Evaluation ◽  
Urgent Care ◽  
Induced Demand ◽  
Care Services ◽  
Primary Care Services ◽  
Additional Demand ◽  
System Factors ◽  
Primary Care Clinicians

BackgroundEvidence from evaluations of emergency departments (EDs) with co-located primary care services suggests that they influence additional demand for non-urgent care (provider-induced demand). In a realist review of the literature on the effects of primary care services in EDs we proposed a theory that when primary care services are distinct at an ED they may encourage additional primary care demand and when primary care clinicians work indistinctly in the ED there is no additional demand. We aimed to explore evidence for this theory and explain contexts, mechanisms and outcomes that influence such demand.MethodsWe used realist evaluation methodology and carried out observations of key processes. We interviewed 23 patients, 21 ED clinical directors, 26 other ED staff members and 26 GPs at 13 EDs (England & Wales). Field notes and audio-recorded interviews were transcribed and analysed by creating context, mechanism and outcome configurations to refine and develop theories relating to provider induced demand.ResultsEDs with distinct primary care services were perceived to attract more demand for primary care than EDs where primary care clinicians worked indistinctly because the primary care service was visible, widely known about, enabled direct access, and received NHS 111 referrals. Other influences on demand were patients’ experiences of accessing primary care, the capacity for urgent care in the community, location of the ED and public transport links, service design and developments (new buildings, renovations) and population characteristics (unfamiliarity with local healthcare services, not registered with a GP or different cultural perceptions of seeking health care).ConclusionsA range of patient, local-system and wider-system factors contribute to additional demand at an ED with co-located primary care services. Our findings can inform providers and policymakers in developing strategies to limit the effect of these influences on additional demand.

Effect of a Reduced Postpartum Length of Stay Program on Primary Care Services Use by Mothers and Infants

PEDIATRICS ◽  
2000 ◽  
Vol 106 (Supplement_3) ◽  
pp. 937-941
Author(s):  
Kenneth D. Mandl ◽  
Charles J. Homer ◽  
Oren Harary ◽  
Jonathan A. Finkelstein
Keyword(s):  
Primary Care ◽  
Length Of Stay ◽  
Early Discharge ◽  
Urgent Care ◽  
Care Utilization ◽  
Care Services ◽  
Primary Care Services ◽  
Ambulatory Services ◽  
The Impact ◽  
Services Use

Objective. To determine the impact of reduced postpartum length of stay (LOS) on primary care services use. Methods. Design: Retrospective quasiexperimental study, comparing 3 periods before and 1 period after introducing an intervention and adjusting for time trends.Setting: A managed care plan.Intervention: A reduced obstetrical LOS program (ROLOS), offering enhanced education and services.Participants: mother-infant dyads, delivered during 4 time periods: February through May 1992, 1993, and 1994, before ROLOS, and 1995, while ROLOS was in effect.Independent Measures: Pre-ROLOS or the post-ROLOS year.Outcome Measures: Telephone calls, visits, and urgent care events during the first 3 weeks postpartum summed as total utilization events. Results. Before ROLOS, LOS decreased gradually (from 51.6 to 44.3 hours) and after, sharply to 36.5 hours. Although primary care use did not increase before ROLOS, utilization for dyads increased during ROLOS. Before ROLOS, there were between 2.37 and 2.72 utilization events per dyad; after, there were 4.60. Well-child visits increased slightly to .98 visits per dyad, but urgent visits did not. Conclusion. This program resulted in shortened stays and more primary care use. There was no increase in infant urgent primary care utilization. Early discharge programs that incorporate and reimburse for enhanced ambulatory services may be safe for infants; these findings should not be extrapolated to mandatory reduced LOS initiatives without enhancement of care.

The Role of the Primary Care Physician in the Care of Children with Serious Heart Disease

PEDIATRICS ◽  
1994 ◽  
Vol 94 (3) ◽  
pp. 284-290
Author(s):  
Paul C. Young ◽  
Yu Shyr ◽  
M. Anthony Schork
Keyword(s):  
Primary Care ◽  
Heart Disease ◽  
Chronic Illness ◽  
Medical Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Care Needs ◽  
Care Services ◽  
Primary Care Services

Objective. To determine the roles of primary care physicians and specialists in the medical care of children with serious heart disease. Setting. Pediatric Cardiology Division; Tertiary Care Children's Hospital. Subjects. Convenience sample of parents, primary care physicians, and pediatric cardiologists of 92 children with serious heart disease. Design. Questionnaire study; questionnaires based on 16 medical care needs, encompassing basic primary care services, care specific to the child's heart disease and general issues related to chronic illness. Results. All children had a primary care physician (PCP), and both they and the parents (P) reported high utilization of PCP for basic primary care services. However, there was little involvement of PCP in providing care for virtually any aspect of the child's heart disease. Parents expressed a low level of confidence in the ability of PCP in general or their child's own PCP to meet many of their child's medical care needs. Both PCP and pediatric cardiologists (PC) were significantly more likely than parents to see a role for PCP in providing for care specific to the heart disease as well as more general issues related to chronic illness. PC and PCP generally agreed about the role PCP should play, although PC saw a bigger role for PCP in providing advice about the child's activity than PCP themselves did. PC were less likely to see the PCP as able to follow the child for long term complications than PCP did. PC were more likely than PCP to believe that PCP were too busy or were inadequately reimbursed to care for children with serious heart disease. Only about one-third of parents reported discussing psychosocial, family, economic, or genetic issues with any provider, and PCP were rarely involved in these aspects of chronic illness. Conclusions. Primary care physicians do not take an active role in managing either the condition-specific or the more general aspects of this serious chronic childhood illness. With appropriate information and support from their specialist colleagues primary care physicians could provide much of the care for this group of children. Generalists and specialists are both responsible for educating and influencing parents about the role primary care physicians can play in caring for children with serious chronic illness.

Urgent Care Centers

2014 ◽  
pp. 63-85
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Occupational Medicine ◽  
Urgent Care ◽  
Care Services ◽  
Primary Care Services ◽  
Per Capita ◽  
Urgent Care Centers ◽  
Care Costs

This chapter focuses on urgent care centers as a unique innovation that has been in the making for the last 30 years. Urgent care centers provide unscheduled or walk-in care, are open for extended hours on weeknights and weekends, and provide services that go beyond what primary care physicians provide, such as occupational medicine, laboratory tests, and fracture care such as splinting and casting, with some providing intravenous fluids, routine immunizations, and primary care services. This chapter describes in-depth the history and growth, operations, and stakeholders of urgent care centers, and overviews the research that relates to quality of care, costs, and patient satisfaction in these centers. Given the expanding industry, strong growth in company numbers, greater employment opportunities, and rising per-capita usage of urgent care centers, the author argues that the urgent care industry is in the growth phase of its life cycle.

scholarly journals Primary care services co-located with Emergency Departments across a UK region: early views on their development

2017 ◽  
Vol 34 (10) ◽  
pp. 672-676 ◽  
Author(s):  
Suzanne Ablard ◽  
Colin O’Keeffe ◽  
Shammi Ramlakhan ◽  
Suzanne M Mason
Keyword(s):  
Primary Care ◽  
Emergency Departments ◽  
Care Services ◽  
Primary Care Services

scholarly journals Learning from diagnostic error when primary care services are located in or alongside emergency departments: a theory generating mixed-methods study

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703277
Author(s):  
Alison Cooper ◽  
Andrew Carson-Stevens ◽  
Niro Siriwardena ◽  
Adrian Edwards
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Emergency Departments ◽  
Care Service ◽  
Diagnostic Error ◽  
Learning System ◽  
Care Staff ◽  
Care Services ◽  
Primary Care Services ◽  
Service Models

BackgroundNew healthcare service models are being introduced to help manage increasing demand on emergency healthcare systems including the provision of primary care services in or alongside emergency departments. There is little research evidence to guide decisions about how service models can be most effective and safe.AimFocusing on diagnostic error, the aim was to learn why errors occur to identify priority interventions.MethodTwo data sources were used to identify diagnostic error reports including: coroners’ reports to prevent future deaths; and the National Reporting and Learning System (NRLS). A cross-sectional, mixed-methods theory-generating study which used a multi-axial PISA classification system based on the recursive model for incident analysis, was carried out.ResultsNine Coroners’ reports (from a total of 1347 community and hospital reports, 2013–2018) and 217 NRLS reports (from 13 million, 2005–2015) were identified describing diagnostic error with learning relevant to primary care services in or alongside emergency departments. Clinical presentations included musculoskeletal injuries; unwell infants; headaches; and chest pains. Findings highlighted a difficulty identifying appropriate patients for the primary care service; underinvestigation; misinterpretation of diagnostic tests; underuse of safeguarding protocols; and inadequate communication and referral pathways between the services.ConclusionPriority areas to minimise risk of diagnostic error when primary care services are located in or alongside emergency departments include clinical decision support to triage and stream patients to the appropriate care setting; contextualised, workplace-based education and training for primary care staff; and standardised computer systems, communication and referral pathways between emergency and primary care services.

scholarly journals The impact of general practitioners working in or alongside emergency departments: a rapid realist review

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e024501 ◽  
Author(s):  
Alison Cooper ◽  
Freya Davies ◽  
Michelle Edwards ◽  
Pippa Anderson ◽  
Andrew Carson-Stevens ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
General Practitioners ◽  
Patient Experience ◽  
Emergency Departments ◽  
Care Facility ◽  
Patient Choice ◽  
Care Services ◽  
Primary Care Services ◽  
The Impact

ObjectivesWorldwide, emergency healthcare systems are under intense pressure from ever-increasing demand and evidence is urgently needed to understand how this can be safely managed. An estimated 10%–43% of emergency department patients could be treated by primary care services. In England, this has led to a policy proposal and £100 million of funding (US$130 million), for emergency departments to stream appropriate patients to a co-located primary care facility so they are ‘free to care for the sickest patients’. However, the research evidence to support this initiative is weak.DesignRapid realist literature review.SettingEmergency departments.Inclusion criteriaArticles describing general practitioners working in or alongside emergency departments.AimTo develop context-specific theories that explain how and why general practitioners working in or alongside emergency departments affect: patient flow; patient experience; patient safety and the wider healthcare system.ResultsNinety-six articles contributed data to theory development sourced from earlier systematic reviews, updated database searches (Medline, Embase, CINAHL, Cochrane DSR & CRCT, DARE, HTA Database, BSC, PsycINFO and SCOPUS) and citation tracking. We developed theories to explain: how staff interpret the streaming system; different roles general practitioners adopt in the emergency department setting (traditional, extended, gatekeeper or emergency clinician) and how these factors influence patient (experience and safety) and organisational (demand and cost-effectiveness) outcomes.ConclusionsMultiple factors influence the effectiveness of emergency department streaming to general practitioners; caution is needed in embedding the policy until further research and evaluation are available. Service models that encourage the traditional general practitioner approach may have shorter process times for non-urgent patients; however, there is little evidence that this frees up emergency department staff to care for the sickest patients. Distinct primary care services offering increased patient choice may result in provider-induced demand. Economic evaluation and safety requires further research.PROSPERO registration numberCRD42017069741.

scholarly journals Taxonomy of the form and function of primary care services in or alongside emergency departments: concepts paper

2019 ◽  
Vol 36 (10) ◽  
pp. 625-630 ◽  
Author(s):  
Alison Cooper ◽  
Michelle Edwards ◽  
Janet Brandling ◽  
Andrew Carson-Stevens ◽  
Matthew Cooke ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Emergency Departments ◽  
Service Providers ◽  
Routine Data ◽  
Emergency Department Patient ◽  
Classification Systems ◽  
Care Services ◽  
Primary Care Services ◽  
And Function

Primary care services in or alongside emergency departments look and function differently and are described using inconsistent terminology. Research to determine effectiveness of these models is hampered by outdated classification systems, limiting the opportunity for data synthesis to draw conclusions and inform decision-making and policy. We used findings from a literature review, a national survey of Type 1 emergency departments in England and Wales, staff interviews, other routine data sources and discussions from two stakeholder events to inform the taxonomy. We categorised the forms inside or outside the emergency department: inside primary care services may be integrated with emergency department patient flow or may run parallel to that activity; outside services may be offered on site or off site. We then describe a conceptual spectrum of integration: identifying constructs that influence how the services function—from being closer to an emergency medicine service or to usual primary care. This taxonomy provides a basis for future evaluation of service models that will comprise the evidence base to inform policy-making in this domain. Commissioners and service providers can consider these constructs in characterising and designing services depending on local circumstances and context.

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