Abstract
OBJECTIVE: To determine the characteristics of primary care attenders to St Mary's Hospital accident and emergency (A&E) department, evaluate the effects of the introduction of general practitioners (GPs) on patient care in A&E, and make recommendations for the provision of GPs in appropriate A&E departments. DESIGN: Prospective survey over a six week period. METHODS: Data collected from the attendances of 970 consecutive patients triaged with "minor" primary care problems, whether seen by A&E doctors or by GPs working in A&E, were analysed. RESULTS: During the study period 1078 patients (16.6%) were triaged as suitable for primary care. The A&E GPs saw 58.4% of these patients. The majority of primary care patients were young British residents, 71.1% of whom were registered with a GP. Sixty per cent of patients lived within St Mary's catchment area. Of those registered patients asked why they attended A&E, 27.1% thought their problem inappropriate for their GP. A&E doctors were more likely to investigate patients and arrange hospital follow up than GPs, who arranged community follow up in 80% of patients needing further care. CONCLUSIONS: The demand for primary care at St Mary's necessitates the provision of a primary care service, albeit for the first visit only. This can be provided by GPs in A&E. The features of the patients using the service suggests that discouraging first attendance is unrealistic, but using the visit to educate patients and return them to the care of the community is not.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Davies T. Accident department or general practice? Br Med J (Clin Res Ed) 1986 Jan 25;292(6515):241–243. doi: 10.1136/bmj.292.6515.241. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Green J., Dale J., Glucksman E. Half the aggro. Health Serv J. 1991 Oct 24;101(5275):25–25. [PubMed] [Google Scholar]
- Hallam L. Primary medical care outside normal working hours: review of published work. BMJ. 1994 Jan 22;308(6923):249–253. doi: 10.1136/bmj.308.6923.249. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jankowski R. F., Mandalia S. Comparison of attendance and emergency admission patterns at accident and emergency departments in and out of London. BMJ. 1993 May 8;306(6887):1241–1243. doi: 10.1136/bmj.306.6887.1241. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McKee C. M., Gleadhill D. N., Watson J. D. Accident and emergency attendance rates: variation among patients from different general practices. Br J Gen Pract. 1990 Apr;40(333):150–153. [PMC free article] [PubMed] [Google Scholar]
- Milner P. C., Nicholl J. P., Williams B. T. Variation in demand for accident and emergency departments in England from 1974 to 1985. J Epidemiol Community Health. 1988 Sep;42(3):274–278. doi: 10.1136/jech.42.3.274. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Nguyen-Van-Tam J. S., Baker D. M. General practice and accident and emergency department care: does the patient know best? BMJ. 1992 Jul 18;305(6846):157–158. doi: 10.1136/bmj.305.6846.157. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Owens C. W., Ben-Shlomo Y., Moore F. P. Accident and emergency in London. Better primary care won't affect self referrals. BMJ. 1993 Jun 26;306(6894):1751–1751. doi: 10.1136/bmj.306.6894.1751-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Prince M., Worth C. A study of 'inappropriate' attendances to a paediatric Accident and Emergency Department. J Public Health Med. 1992 Jun;14(2):177–182. [PubMed] [Google Scholar]
- Singh S. Self referral to accident and emergency department: patients' perceptions. BMJ. 1988 Nov 5;297(6657):1179–1180. doi: 10.1136/bmj.297.6657.1179. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wilkinson A., Kazantzis G., Williams D. J., Dewar R. A., Bristow K. M., Miller D. L. Attendance at a London casualty department. J R Coll Gen Pract. 1977 Dec;27(185):727–733. [PMC free article] [PubMed] [Google Scholar]