Referral outcomes of attendances at general practitioner led urgent care centres in London, England: retrospective analysis of hospital administrative data

Cowling, Thomas E; Ramzan, Farzan; Ladbrooke, Tim; Millington, Hugh; Majeed, Azeem; Gnani, Shamini

doi:10.1136/emermed-2014-204603

Cited by 20 publications

(18 citation statements)

References 25 publications

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“…Urgent care centres (UCCs) have also been implemented in the USA and UK and were intended to reduce rates of ED visits and short-stay emergency admissions to hospital. However, more research is needed to examine the effect of the introduction of the UCCs on the frequency of ED attendance and emergency admissions to hospital, especially when the UCC is not colocated with the ED 76…”

Section: Discussionmentioning

confidence: 99%

Factors associated with inappropriate use of emergency departments: findings from a cross-sectional national study in France

et al. 2019

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BackgroundInappropriate visits to emergency departments (EDs) could represent from 20% to 40% of all visits. Inappropriate use is a burden on healthcare costs and increases the risk of ED overcrowding. The aim of this study was to explore socioeconomic and geographical determinants of inappropriate ED use in France.MethodThe French Emergency Survey was a nationwide cross-sectional survey conducted on June 11 2013, simultaneously in all EDs in France and covered characteristics of patients, EDs and counties. The survey included 48 711 patient questionnaires and 734 ED questionnaires. We focused on adult patients (≥15 years old). The appropriateness of the ED visit was assessed by three measures: caring physician appreciation of appropriateness (numeric scale), caring physician appreciation of whether or not the patient could have been managed by a general practitioner and ED resource utilisation. Descriptive statistics and multilevel logistic regression were used to examine determinants of inappropriate ED use, estimating adjusted ORs and 95% CIs.ResultsAmong the 29 407 patients in our sample, depending on the measuring method, 13.5% to 27.4% ED visits were considered inappropriate. Regardless of the measure method used, likelihood of inappropriate use decreased with older age and distance from home to the ED >10 km. Not having a private supplementary health insurance, having universal supplementary health coverage and symptoms being several days old increased the likelihood of inappropriate use. Likelihood of inappropriate use was not associated with county medical density.ConclusionInappropriate ED use appeared associated with socioeconomic vulnerability (such as not having supplementary health coverage or having universal coverage) but not with geographical characteristics. It makes us question the appropriateness of the concept of inappropriate ED use as it does not consider the distress experienced by the patient, and segments of society seem to have few other choices to access healthcare than the ED.

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Section: Discussionmentioning

confidence: 99%

Factors associated with inappropriate use of emergency departments: findings from a cross-sectional national study in France

et al. 2019

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“…A higher number of ED physicians were in favour of a co-location as compared to the GP's. GP's are reluctant to be involved in hospital care fearing that their input and expertise will be overruled or even dispensable (8,11,30) Therefore, in a co-location care system a strict owchart and role de nition is very important (17,23,31). Both groups con rmed indeed that a co-location might improve the adequacy of referral, lower the workload and decrease waiting times.…”

Section: Discussionmentioning

confidence: 98%

Co-location of Out of Hours Primary Care and Emergency Department in Belgium: Patients’ and Physicians’ View

Schoenmakers

Criekinge

Boeve

et al. 2020

Preprint

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Background In Belgium, General Practitioner Cooperatives (GPC) aim to improve working conditions for unplanned care and to reduce the number of inappropriate emergency visits. Although this system is well organised, the number of inappropriate visits does not decrease. Methods We explored the position of patients and physicians on the co-location of a GPC and an emergency service for unplanned care. The study was carried out in a cross section design in primary and emergency care services, including patients and physicians. Main outcome measures were the position of patients and physician on co-location a GPC and an emergency service. Results 404 patients and 488 physicians participated. 334 (82.7%) of all patients favored a co-location. The most important advantages were fast service (104, 25.7) and adequate referral (54, 13.4%). 237 (74%) of the GP’s and 38 (95%) of the emergency physicians were in favor of a co-location. The major advantage of this system was a more adequate referral of patients. 254 (79%) of the GP’s and 23 (83%) of the emergency physicians believed that a co-location would lower the workload, decrease waiting time and increase care quality (resp. 251 (78%), 224 (70%) and 37 (93%), 34 (85%). Conclusions To meet all concerns and to reach for high care quality information campaigns and development of workflows are necessary for a successful implementation of a co-location of primary and emergency care.

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“…24 It also reflects what was seen in the overall population, including adults, attending the same GP-led UCCs. 25 It could be extrapolated that if they do not require admission then a large number of these attendances are ‘inappropriate’; 27% of attendances were either for an upper respiratory tract infection or a viral infection.…”

Section: Discussionmentioning

confidence: 99%

Healthcare use among preschool children attending GP-led urgent care centres: a descriptive, observational study

et al. 2016

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ObjectiveUrgent care centres’ (UCCs) hours were developed with the aim of reducing inappropriate emergency department (ED) attendances in England. We aimed to examine the presenting complaint and outcomes of care in 2 general practitioner (GP)-led UCCs with extended opening times.DesignRetrospective observational epidemiological study using routinely collected data.Setting2 GP-led UCCs in London, colocated with a hospital ED.ParticipantsAll children aged under 5 years, attending 2 GP-led UCCs over a 3-year period.OutcomesOutcomes of care for the children including: primary diagnosis; registration status with a GP; destination following review within the UCC; and any medication prescribed. Comparison between GP-led UCC visit rates and routine general practices was also made.Results3% (n=7747/282 947) of all attenders at the GP-led UCCs were children aged under 5 years. The most common reason for attendance was a respiratory illness (27%), followed by infectious illness (17%). 18% (n=1428) were either upper respiratory tract infections or viral infections. The majority (91%) of children attending were registered with a GP, and over two-thirds of attendances were ‘out of hours’. Overall 79% were seen and discharged home. Preschool children were more likely to attend their GP (47.0 per 100) than a GP-led UCC (9.4 per 100; 95% CI 8.9 to 10.0).ConclusionsTwo-thirds of preschool children attending GP-led UCCs do so out of hours, despite the majority being registered with a GP. The case mix is comparable with those presenting to an ED setting, with the majority managed exclusively by the GPs in the UCC before discharge home. Further work is required to understand the benefits of a GP-led urgent system in influencing future use of services especially emergency care.

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Referral outcomes of attendances at general practitioner led urgent care centres in London, England: retrospective analysis of hospital administrative data

Cited by 20 publications

References 25 publications

Factors associated with inappropriate use of emergency departments: findings from a cross-sectional national study in France

Factors associated with inappropriate use of emergency departments: findings from a cross-sectional national study in France

Co-location of Out of Hours Primary Care and Emergency Department in Belgium: Patients’ and Physicians’ View

Healthcare use among preschool children attending GP-led urgent care centres: a descriptive, observational study

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