Author:
McFadzean I. J.,Edwards M.,Davies F.,Cooper A.,Price D.,Carson-Stevens A.,Dale J.,Hughes T.,Porter A.,Harrington B.,Evans B.,Siriwardena N.,Anderson P.,Edwards A.
Abstract
Abstract
Background
It is not known whether emergency departments (EDs) with primary care services influence demand for non-urgent care (‘provider-induced demand’). We proposed that distinct primary care services in EDs encourages primary care demand, whereas primary care integrated within EDs may be less likely to cause additional demand. We aimed to explore this and explain contexts (C), mechanisms (M) and outcomes (O) influencing demand.
Methods
We used realist evaluation methodology and observed ED service delivery. Twenty-four patients and 106 staff members (including Clinical Directors and General Practitioners) were interviewed at 13 EDs in England and Wales (240 hours of observations across 30 days). Field notes from observations and interviews were analysed by creating ‘CMO’ configurations to develop and refine theories relating to drivers of demand.
Results
EDs with distinct primary care services were perceived to attract demand for primary care because services were visible, known or enabled direct access to health care services. Other influencing factors included patients’ experiences of accessing primary care, community care capacity, service design and population characteristics.
Conclusions
Patient, local-system and wider-system factors can contribute to additional demand at EDs that include primary care services. Our findings can inform service providers and policymakers in developing strategies to limit the effect of potential influences on additional demand when demand exceeds capacity.
Funder
NIHR School for Primary Care Research
Publisher
Springer Science and Business Media LLC
Reference37 articles.
1. Cooper A, et al. The impact of general practitioners working in or alongside emergency departments: a rapid realist review. BMJ Open. 2019;9(4):e024501.
2. Gonçalves-Bradley D, et al. Primary care professionals providing non-urgent care in hospital emergency departments. Cochrane Database Syst Rev. 2018;2(2):CD002097.
3. Roemer MI. Bed supply and hospital utilization: a natural experiment. Hospitals. 1961;35:36–42.
4. National Guideline, C., National Institute for Health and Care Excellence. Clinical Guidelines, in Emergency and acute medical care in over 16s: service delivery and organisation. London: National Institute for Health and Care Excellence (UK) Copyright © NICE 2018; 2018.
5. Ramlakhan S, et al. Primary care services located with EDs: a review of effectiveness. Emerg Med J. 2016;33(7):495–503.
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