J. Dale et al., PRIMARY-CARE IN THE ACCIDENT AND EMERGENCY DEPARTMENT .2. COMPARISON OF GENERAL-PRACTITIONERS AND HOSPITAL DOCTORS, BMJ. British medical journal, 311(7002), 1995, pp. 427-430
Objective-To compare the process and outcome of ''primary care'' consu
ltations undertaken by senior house officers, registrars, and general
practitioners in an accident and emergency department. Design-Prospect
ive, controlled intervention study. Setting-A busy, inner city acciden
t and emergency department in south London. Subjects-Patients treated
during a stratified random sample of 419 three hour sessions between J
une 1989 and May 1990 assessed at nurse triage as presenting with prob
lems that could be treated in a primary care setting. 1702 of these pa
tients were treated by sessionally employed local general practitioner
s, 2382 by senior house officers, and 557 by registrars. Main outcome
measures-Process variables: laboratory and radiographic investigations
, prescriptions, and referrals; outcome variables: results of investig
ations. Results-Primary care consultations made by accident and emerge
ncy medical staff resulted in greater utilisation of investigative, ou
tpatient, and specialist services than those made by general practitio
ners. For example, the odds ratios for patients receiving radiography
were 2.78 (95% confidence interval 2.32 to 3.34) for senior house offi
cer v general practitioner consultations and 2.37 (1.84 to 3.06) for r
egistrars v general practitioners. For referral to hospital specialist
on call teams or outpatient departments v discharge to the community
the odds ratios were 2.88 (2.39 to 3.47) for senior house officers v g
eneral practitioners and 2.57 (1.98 to 3.35) for registrars v general
practitioners. Conclusion-Employing general practitioners in accident
and emergency departments to manage patients with primary care needs s
eems to result in reduced rates of investigations, prescriptions, and
referrals. This suggests important benefits in terms of resource utili
sation, but the impact on patient outcome and satisfaction needs to be
considered further.