scholarly journals Impact of GP gatekeeping on quality of care, and health outcomes, use, and expenditure: a systematic review

2019 ◽  
Vol 69 (682) ◽  
pp. e294-e303 ◽  
Author(s):  
Poompong Sripa ◽  
Benedict Hayhoe ◽  
Priya Garg ◽  
Azeem Majeed ◽  
Geva Greenfield
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Health Outcomes ◽  
Direct Access ◽  
Cochrane Library ◽  
Patients With Cancer ◽  
The Impact

BackgroundGPs often act as gatekeepers, authorising patients’ access to specialty care. Gatekeeping is frequently perceived as lowering health service use and health expenditure. However, there is little evidence suggesting that gatekeeping is more beneficial than direct access in terms of patient- and health-related outcomes.AimTo establish the impact of GP gatekeeping on quality of care, health use and expenditure, and health outcomes and patient satisfaction.Design and settingA systematic review.MethodThe databases MEDLINE, PreMEDLINE, Embase, and the Cochrane Library were searched for relevant articles using a search strategy. Two authors independently screened search results and assessed the quality of studies.ResultsElectronic searches identified 4899 studies (after removing duplicates), of which 25 met the inclusion criteria. Gatekeeping was associated with better quality of care and appropriate referral for further hospital visits and investigation. However, one study reported unfavourable outcomes for patients with cancer under gatekeeping, and some concerns were raised about the accuracy of diagnoses made by gatekeepers. Gatekeeping resulted in fewer hospitalisations and use of specialist care, but inevitably was associated with more primary care visits. Patients were less satisfied with gatekeeping than direct-access systems.ConclusionGatekeeping was associated with lower healthcare use and expenditure, and better quality of care, but with lower patient satisfaction. Survival rate of patients with cancer in gatekeeping schemes was significantly lower than those in direct access, although primary care gatekeeping was not otherwise associated with delayed patient referral. The long-term outcomes of gatekeeping arrangements should be carefully studied before devising new gatekeeping policies.

scholarly journals A systematic review of the impact of nurse practitioners on cost, quality of care, satisfaction and wait times in the emergency department

CJEM ◽  
2007 ◽  
Vol 9 (04) ◽  
pp. 286-295 ◽  
Author(s):  
Alix J.E. Carter ◽  
Alecs H. Chochinov
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Nurse Practitioners ◽  
Census Data ◽  
Medical Community ◽  
Wait Times ◽  
The Impact

ABSTRACT Introduction: US emergency personnel cared for 106% more patients in 1990 than they did in 1980, and national emergency department census data show that 60%–80% of those patients presented with non-urgent or minor medical problems. The hiring of nurse practitioners (NPs) is one proposed solution to the ongoing overcrowding and physician shortage facing emergency departments (EDs). Methods: We conducted a systematic review of MEDLINE and Cinahl to find articles that discussed NPs in the ED setting, looking specifically at 4 key outcome measures: wait times, patient satisfaction, quality of care and cost effectiveness. Results: Although some questions remain, a review of the literature suggests that NPs can reduce wait times for the ED, lead to high patient satisfaction and provide a quality of care equal to that of a mid-grade resident. Cost, when compared with resident physicians, is higher; however, data comparing to the hiring additional medical professionals is lacking. Conclusion: The medical community should further explore the use of NPs, particularly in fast track areas for high volume departments. In rural areas, NPs could supplement overextended physicians and allow health centres to remain open when they might otherwise have to close. These strategies could improve access to care and patient satisfaction for selected urban and rural populations as well as make the best use of limited medical resources.

scholarly journals Has the implementation of time-based-targets for emergency department length-of-stay influenced the quality of care for patients? A systematic review of qualitative literature

2021 ◽  
Author(s):  
Katie Walker ◽  
Bridget Honan ◽  
Daniel Haustead ◽  
David Mountain ◽  
Vinay Gangathimmaiah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Quality Of Care ◽  
Length Of Stay ◽  
Cochrane Library ◽  
Research Approach ◽  
Successful Implementation ◽  
The Impact ◽  
Qualitative Literature

abstractBackgroundTime-based-targets for emergency department length-of-stay were introduced in England in 2000; followed by Canada, Ireland, New Zealand, and Australia after emergency department crowding was associated with poor quality of care and increased mortality.ObjectivesThe aim of the systematic review was to evaluate qualitative literature to investigate how implementing time-based-targets for emergency department length-of-stay has influenced the quality of care of patients.MethodsSystematic review of qualitative studies that described knowledge, attitudes to or experiences regarding a time-based-target for emergency department length-of-stay. Searches were conducted in Cochrane library, Medline, Embase, CInAHL, Emerald, ABI/Inform, and Informit. Individual studies were evaluated using the Critical Appraisal Skills Programme tool. Individual study findings underwent thematic analysis. Confidence in findings was assessed using the Confidence in the Evidence from Reviews of Qualitative research approach.ResultsThe review included thirteen studies from four countries, incorporating 617 interviews. Themes identified were: quality of care, access block and overcrowding, patient experience, staff morale and workload, intrahospital and interdepartmental relationships, clinical education and training, gaming, and enablers and barriers to achieving targets. The confidence in findings is moderate or high for most themes. More patient and junior doctor perspectives are needed.ConclusionsEmergency time-based-targets have impacted on the quality of emergency patient care. The impact can be both positive and negative and successful implementation depends on whole hospital resourcing and engagement with targets.FundingThe Australasian College for Emergency Medicine provided administrative support for the study, no funding was received.RegistrationPROSPERO CRD42019107755 (prospective)

scholarly journals Inequalities in general practice remote consultations: A systematic review

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0040
Author(s):  
Ruth Parker ◽  
Emma Figures ◽  
Charlotte Paddison ◽  
James Matheson ◽  
David Blane ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
General Practice ◽  
Quality Of Care ◽  
Clinical Outcomes ◽  
The Elderly ◽  
Face To Face ◽  
The Impact ◽  
Remote Consultations

BackgroundCOVID-19 has led to rapid and widespread use of remote consultations in general practice, but the health inequalities impact remains unknown.AimTo explore the impact of remote consultations in general practice compared to face-to-face consultations on utilisation and clinical outcomes across socio-economic and disadvantaged groups.Design & settingSystematic reviewMethodWe undertook an electronic search of MEDLINE, EMBASE and Web of Science from inception to June 2020. We included studies which compared remote consultations to face-to-face consultations in primary care and reported outcomes by PROGRESS Plus criteria. Risk of bias was assessed using ROBINS-I. Data was synthesised narratively.ResultsBased on 13 studies, exploring telephone and internet-based consultations, we found that telephone consultations were used by younger working age people, the very old and non-immigrants, with internet-based consultations more likely to be used by younger people. Women consistently used more remote forms of consulting than men. Socio-economic and ethnicity findings were mixed, with weak evidence that patients from more affluent areas were more likely to use internet-based communication. Remote consultations appeared to help patients with opioid dependence remain engaged with primary care. No studies reported on the impact on quality of care or clinical outcomes.ConclusionRemote consultations in general practice are likely to be used more by younger working people, non-immigrants, the elderly and women, with internet-based consultations more by younger, affluent and educated groups. Wide-spread use of remote consultations should be treated with caution until the inequalities impact on clinical outcomes and quality of care is known.

scholarly journals Medicines Related Problems (MRPs) Originating in Primary Care Settings in Older Adults - A Systematic Review

2021 ◽  
pp. 089719002110236
Author(s):  
Rosetta Chinyere Ude-Okeleke ◽  
Zoe Aslanpour ◽  
Soraya Dhillon ◽  
Nkiruka Umaru
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Library Science ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Data Bases ◽  
Primary Care Settings ◽  
Preventative Interventions ◽  
Use Of Health Services

Background: As people age, they become increasingly vulnerable to the untoward effects of medicines due to changes in body systems. These may result in medicines related problems (MRPs) and consequent decline or deterioration in health. Aim: To identify MRPs, indicators of deterioration associated with these MRPs, and preventative interventions from the literature. Design and Setting: Systematic review of primary studies on MRPs originating in Primary Care in older people. Methods: Relevant studies published between 2001 and April 2018 were obtained from Medline (via PubMed), CINAHL, Embase, Psych Info, PASCAL, Scopus, Cochrane Library, Science Direct, and Zetoc. Falls, delirium, pressure ulcer, hospitalization, use of health services and death were agreed indicators of deterioration. The methodological quality of included studies was assessed using the Down and Black tool. Results: There were 1858 articles retrieved from the data bases. Out of these, 21 full text articles met inclusion criteria for the review. MRPs identified were medication error, potentially inappropriate medicines, adverse drug reaction and non-adherence. These were associated with indicators of deterioration. Interventions that involved doctors, pharmacists and patients in planning and implementation yielded benefits in halting MRPs. Conclusion: This Systematic review summarizes MRPs and associated indicators of deterioration. Appropriate interventions appeared to be effective against certain MRPs and their consequences. Further studies to explore deterioration presented in this systematic review is imperative.

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