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Dale, Jeremy
Languages: English
Types: Doctoral thesis

Classified by OpenAIRE into

mesheuropmc: education
The thesis describes the development, research and evaluation of the applicability of a new\ud model of care that involves GPs being employed on a sessional basis in A&E departments to\ud treat patients attending with primary care needs. The main aim of the study was to research its\ud cost and clinical effectiveness.\ud A multi-faceted approach was taken to include consideration of patients' needs and preferences,\ud professional concerns, organisational and structural issues within the health service, and\ud planning and policy issues. Clinical, sociological, epidemiological, and economic perspectives\ud are drawn upon, reflecting the context of the service development and to provide a firm base\ud for discussion about the generalisability and applicability of the findings.\ud The first two chapters provide a detailed review of the epidemiological, sociological,\ud clinical, and organisational literature relating to the primary care/A&E interface. The\ud incentives and disincentives that may act to increase or reduce demand and supply are\ud explored, in addition to issues relating to the 'appropriateness' of demand, the\ud organisational culture of A&E departments, and strategies used to curtail or cope with\ud demand. The demand for primary care at A&E departments appears to cross national\ud boundaries and hence, literature from other countries (particularly the USA) is included\ud and its applicability to the UK considered. Relevant literature relating to the quality of A&E\ud care, patient satisfaction, and the costing of care is also discussed.\ud The main study was a prospective controlled trial that was conducted at King's College\ud Hospital. This compared process variables, clinical outcome and costs of 'primary care'\ud consultations performed by senior house officers (SHOs), registrars, and general\ud practitioners working three-hour sessions in A&E. A new system of nurse triage was\ud implemented to allow the prospective identification of patients presenting with primary care\ud needs. A total of 27 SHOs, three registrars and one senior registrar were included, and the\ud patient sample comprised 1702 patients seen by GPs, 2382 by SHOs, and 557 by registrars or\ud the senior registrar. GPs were found to practice considerably less interventionist care than\ud A&E medical staff, and the resource implications were substantial.\ud The findings are discussed critically, and their applicability is considered drawing on empirical\ud data from recent evaluations of A&E Primary Care Service developments in other parts of\ud London. The policy and service implications of the study are considered and further research\ud needs identified.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 2.2 Review of UK studies (1958-1993) that have surveyed the proportion of workload that is appropriate to A&E Hallam L. Out of hours primary care (editorial). British Medical Journal. 1997,314 157-8.
    • Hansagi H. Referral of non-urgent cases from an emergency department: patient compliance, satisfaction and attitudes. Scandinavian Journal of SocialMedicine. [990;18: 249-255.
    • Hansagi H, Carisson B, Olsson M, Edhag 0. Trial of a method of reducing inappropriate demands on a hospital emergency department. Public Health. 1987;! 01:99-105.
    • Hansagi H, Alleback P. Edhag 0. Health care utilisation after referral from a hospital emergency department. Scandinavian Journal of Social Medicine. 1989; 17:291-9.
    • Hansagi H, Alleback P. Edhag 0. Frequency of emergency department attendances as a predictor of mortality: nine year followup of a population-based cohort. Journal of Public Health Medicine. 1990; 12:39.
    • Hansagi H, Carlsson B, Brismar B. The urgency of care need and patient satisfaction at a hospital emergency department. Health Care Management Review. 1992;! 7:71-75.
    • Hansagi H, Edhag 0, Alleback P. High consumers of health care in emergency units: how to improve their quality of care. Quality Assurance in Health Care. 1991 ;3( 1 ):5 1-62.
    • Hansard. Vol CCCXXXVIII 29 July cols 1553-4. London: House of Lords. 1889.
    • Hardy N. Casualty outpatients. British Medical Journal. !974;( 13 June): 777-8.
    • Hardy RH. Structure and function of a middle sized accident department. British Medical Journal. 1974;2:596-600.
    • Harman H. Accident and emergency at King's College Hospital - response of Harriet Harman, MP, to Camberwell Health Authority's consultation document. London: House of Commons. 1987.
    • Harris B, Fox J. Eye opener at Bristol. Health Service Journal. 1986,96.364-365.
    • Is there a dearth? And if so what's to be done. British Medi cal Journal 1996;312:97-!01.
    • Haynes RM, Bentham CG. The effects of accessibility on general practitioner consultations, outpatient attendances and inpatient admissions in Norfolk, England. Social Science and Medicine. 1982;16:561-9.
    • Hayter P, Peckham S, Robinson R. Morale in general practice. Southampton. Institute of Health Policy Studies. 1995.
    • Haywood IR. Triage. Journal of the British Association for Immediate Care. 1984,7:3 1-5.
    • Head S. Nurse practitioners: the new pioneers. Nursing Times. !988;84 27-28.
    • Hu S-C. Clinical and demographic charactenstics of 13,911 medical emergency patients.
    • Journal of the Formosan Medical Association. 1991,90.675-9.
    • Hunt MT, Glucksman E. A review of 7 years complaints in an inner city A&E department Archives of Emergency Medicine. 1991 ;8.17-23.
    • Hurley RE, Freund DA, Taylor DE. Emergency room use and primary care case management: evidence from four Medicaid demonstration programmes. American Journal of Public Health. 1989a;79 843-6.
    • 1989b, 14.63-7 1.
    • Journal. 1989;298:737-9.
    • Office of Population Censuses and Surveys, 1991 Great Britain. London HMSO. 12, 13, 19 (CEN 91.CM56) 1992.
    • Office of Population Censuses and Surveys, Social Survey Division. General household survey. p 60. London: HMSO. 1990.
    • Rosenzweig S. Emergency rapport. Journal of Emergency Medicine. 1993; 11 775-8.
    • Young GP, Sklar D. Health care reform and emergency medicine Annals of Emergency Medicine. 1995,25 666-74.
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