Impact of initiatives to improve access to, and choice of, primary and urgent care in England: A systematic review

Tan, Stefanie; Mays, Nicholas

doi:10.1016/j.healthpol.2014.07.011

Cited by 36 publications

(44 citation statements)

References 24 publications

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“…A Cochrane review evaluating this concept has shown disparate results, and, owing to the insufficient quality of the individual studies covered by this meta-study, the authors did not draw practical policy conclusions. 28 In Germany, similar concepts are difficult to implement due to the strict separation of inpatient and outpatient care and the subsequent conflicts between healthcare providers on the funding of their services. Until now, primary care provision in German EDs has only been implemented in a few centres 29 but is currently discussed to be expanded.…”

Section: Discussionmentioning

confidence: 99%

Patient motives behind low-acuity visits to the emergency department in Germany: a qualitative study comparing urban and rural sites

et al. 2016

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ObjectivesThe increasing number of low-acuity visits to emergency departments (ED) is an important issue in Germany, despite the fact that all costs of inpatient and outpatient treatment are covered by mandatory health insurance. We aimed to explore the motives of patients categorised with low-acuity conditions for visiting an ED.MethodsWe conducted a qualitative study in two urban and one rural ED. We recruited a purposive sample of adults, who were assigned to the lowest two categories in the Manchester triage system. One-to-one interviews took place in the ED during patients' waiting time for treatment. Interview transcripts were analysed using the qualitative data management software MAXQDA. A qualitative content analysis approach was taken to identify motives and to compare the rural with the urban sites.ResultsA total of 86 patients were asked to participate; of these, n=15 declined participation and n=7 were excluded because they were admitted as inpatients, leaving a final sample of 40 female and 24 male patients. We identified three pathways leading to an ED visit: (1) without primary care contact, (2) after unsuccessful attempts to see a resident specialist or general practitioner (GP) and (3) recommendation to visit the ED by an outpatient provider. The two essential motives were (1) convenience and (2) health anxiety, triggered by time constraints and focused usage of multidisciplinary medical care in a highly equipped setting. All participants from the rural region were connected to a GP, whom they saw more or less regularly, while more interviewees from the urban site did not have a permanent GP. Still, motives to visit the ED were in general the same.ConclusionsWe conclude that the ED plays a pivotal role in ambulatory acute care which needs to be recognised for adequate resource allocation.Trial registration numberDRK S00006053

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Section: Discussionmentioning

confidence: 99%

Patient motives behind low-acuity visits to the emergency department in Germany: a qualitative study comparing urban and rural sites

et al. 2016

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“…28 This includes the target of guaranteed access within 48 hours and financial incentives related to access and opening hours.…”

Section: Does Access Reduce Use Of Emergency Departments?mentioning

confidence: 99%

Evidence and rhetoric about access to UK primary care

Cowling

Harris

Majeed

2015

BMJ

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Evidence and rhetoric about access to UK primary careAs the general election in the UK approaches and NHS policies are set to take centre stage, Thomas E Cowling, Matthew J Harris, and Azeem Majeed discuss the evidence, uncertainty, and debate behind access to primary care Thomas E Cowling National Institute for Health Research doctoral research fellow 1 , Matthew J Harris Commonwealth Fund Harkness fellow in healthcare policy and practice 1 2 , Azeem Majeed professor of primary care 1

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“…Diverting patients from EDs was more pronounced when the walk-in centres were located within hospitals (next to the ED). By contrast, in a systematic review of 40 studies examining the impact of initiatives to improve access to and choice of primary and urgent care in the United Kingdom, Tan and Mays (2014) found a limited impact.…”

mentioning

confidence: 94%

“…The team assesses a patient's symptoms and gives health care advice, or directs patients to the most appropriate services such as EDs, an out-of-hours doctor, an urgent care centre, or a walk-in centre, or arranges an ambulance if medically necessary. In a systematic review of 40 studies examining the impact of initiatives to improve access to and choice of primary and urgent care in the United Kingdom, Tan and Mays (2014) found no significant reduction in ED attendance after the introduction of NHS Direct and NHS 111.…”

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confidence: 99%

“…While some studies found that ED attendances increased after establishing walk-in centres, others indicate that establishing walk-in centres or minor injury units did not significantly reduce ED visits (Tan and Mays, 2014;Pinchbeck, 2014). Several explanations have been proposed as to why new emergency and urgent care services do not provide a perfect substitute for the ED (Tan and Mays, 2014;Pinchbeck, 2014). First, it is possible that new sites of emergency care increase overall demand, by either generating greater service availability or because particular health needs were previously unmet.…”

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confidence: 99%

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