COST-EFFECTIVENESS OF TREATING PRIMARY-CARE PATIENTS IN ACCIDENT AND EMERGENCY - A COMPARISON BETWEEN GENERAL-PRACTITIONERS, SENIOR HOUSE OFFICERS, AND REGISTRARS
J. Dale et al., COST-EFFECTIVENESS OF TREATING PRIMARY-CARE PATIENTS IN ACCIDENT AND EMERGENCY - A COMPARISON BETWEEN GENERAL-PRACTITIONERS, SENIOR HOUSE OFFICERS, AND REGISTRARS, BMJ. British medical journal, 312(7042), 1996, pp. 1340-1344
Objectives-To compare outcome and costs of general practitioners, seni
or house officers, and registrars treating patients who attended accid
ent and emergency department with problems assessed at triage as being
of primary care type. Design-Prospective intervention study which was
later costed. Setting-inner city accident and emergency department in
south east London. Subjects-4631 patients presenting with primary car
e problems: 1702 were seen by general practitioners, 2382 by senior ho
use officers, and 557 by registrars.Main outcome measures-Satisfaction
and outcome assessed in subsample of 565 patients 7-10 days after hos
pital attendance and aggregate costs of hospital care provided. Result
s-Most patients expressed high levels of satisfaction with clinical as
sessment (430/562 (77%)), treatment (418/557 (75%)), and consulting do
ctor's manner (434/492 (88%)). Patients' reported outcome and use of g
eneral practice in 7-10 days after attendance were similar: 206/241 (8
5%), 224/263 (85%), and 52/59 (88%) of those seen by general practitio
ners, senior house officers, and registrars respectively were fully re
covered or improving chi(2)=0.35, P=0.830), while 48/240 (20%), 48/268
(18%), and 12/57 (21%) respectively consulted a general practitioner
or practice nurse (chi(2)=0.51, P=0.774). Excluding costs of admission
s, the average costs per case were pound 19.30, pound 17.97, and pound
11.70 for senior house officers, registrars, and general practitioner
s respectively. With cost of admissions included, these costs were pou
nd 58.25, pound 44.68, and pound 32.30 respectively. Conclusion-Manage
ment of patients with primary care needs in accident and emergency dep
artment by general practitioners reduced costs with no apparent detrim
ental effect on outcome. These results support new role for general pr
actitioners.