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Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation

Freya Davies Orcid Logo, Michelle Edwards Orcid Logo, Delyth Price Orcid Logo, Pippa Anderson, Andrew Carson-Stevens Orcid Logo, Mazhar Choudhry Orcid Logo, Matthew Cooke Orcid Logo, Jeremy Dale Orcid Logo, Liam Donaldson Orcid Logo, Bridie Evans Orcid Logo, Barbara Harrington, Shaun Harris Orcid Logo, Julie Hepburn, Peter Hibbert Orcid Logo, Thomas Hughes Orcid Logo, Faris Hussain Orcid Logo, Saiful Islam Orcid Logo, Rhys Pockett Orcid Logo, Alison Porter Orcid Logo, Aloysius Niroshan Siriwardena Orcid Logo, Helen Snooks Orcid Logo, Alan Watkins Orcid Logo, Adrian Edwards Orcid Logo, Alison Cooper Orcid Logo

Health and Social Care Delivery Research, Volume: 12, Issue: 10, Pages: 1 - 152

Swansea University Authors: Pippa Anderson, Bridie Evans Orcid Logo, Shaun Harris Orcid Logo, Saiful Islam Orcid Logo, Rhys Pockett Orcid Logo, Alison Porter Orcid Logo, Helen Snooks Orcid Logo, Alan Watkins Orcid Logo

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DOI (Published version): 10.3310/jwqz5348

Abstract

BackgroundEmergency healthcare services are under intense pressure to meet increasing patient demands. Many patients presenting to emergency departments could be managed by general practitioners in general practitioner–emergency department service models.ObjectivesTo evaluate the effectiveness, safe...

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Published in: Health and Social Care Delivery Research
ISSN: 2755-0079
Published: National Institute for Health and Care Research 2024
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Many patients presenting to emergency departments could be managed by general practitioners in general practitioner–emergency department service models.ObjectivesTo evaluate the effectiveness, safety, patient experience and system implications of the different general practitioner–emergency department models.DesignMixed-methods realist evaluation.MethodsPhase 1 (2017–8), to understand current practice: rapid realist literature review, national survey and follow-up key informant interviews, national stakeholder event and safety data analysis. Phase 2 (2018–21), to collect and analyse qualitative (observations, interviews) and quantitative data (time series analysis); cost–consequences analysis of routine data; and case site data for ‘marker condition’ analysis from a purposive sample of 13 case sites in England and Wales. Phase 3 (2021–2), to conduct mixed-methods analysis for programme theory and toolkit development.ResultsGeneral practitioners commonly work in emergency departments, but delivery models vary widely in terms of the scope of the general practitioner role and the scale of the general practitioner service. We developed a taxonomy to describe general practitioner–emergency department service models (Integrated with the emergency department service, Parallel within the emergency department, Outside the emergency department on the hospital site) and present a programme theory as principal output of the study to describe how these service models were observed to operate. Routine data were of variable quality, limiting our analysis. Time series analysis demonstrated trends across intervention sites for: increased time spent in the emergency department; increased emergency department attendances and reattendances; and mixed results for hospital admissions. Evidence on patient experience was limited but broadly supportive; we identified department-level processes to optimise the safety of general practitioner–emergency department models.LimitationsThe quality, heterogeneity and extent of routine emergency department data collection during the study period limited the conclusions. Recruitment was limited by criteria for case sites (time series requirements) and individual patients (with ‘marker conditions’). Pandemic and other pressures limited data collection for marker condition analysis. Data collected and analysed were pre pandemic; new approaches such as ‘telephone first’ and their relevance to our findings remains unexplored.ConclusionFindings suggest that general practitioner–emergency department service models do not meet the aim of reducing the overall emergency department waiting times and improving patient flow with limited evidence of cost savings. Qualitative data indicated that general practitioners were often valued as members of the wider emergency department team. We have developed a toolkit, based on our findings, to provide guidance for implementing and delivering general practitioner–emergency department services.</abstract><type>Journal Article</type><journal>Health and Social Care Delivery Research</journal><volume>12</volume><journalNumber>10</journalNumber><paginationStart>1</paginationStart><paginationEnd>152</paginationEnd><publisher>National Institute for Health and Care Research</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2755-0079</issnElectronic><keywords/><publishedDay>1</publishedDay><publishedMonth>4</publishedMonth><publishedYear>2024</publishedYear><publishedDate>2024-04-01</publishedDate><doi>10.3310/jwqz5348</doi><url/><notes/><college>COLLEGE NANME</college><department>Health and Social Care School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HSOC</DepartmentCode><institution>Swansea University</institution><apcterm>Not Required</apcterm><funders>NIHR Health and Social Care Delivery Research (HSDR) Programme</funders><projectreference/><lastEdited>2024-06-19T12:44:55.3603745</lastEdited><Created>2024-05-01T09:40:32.6827715</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Freya</firstname><surname>Davies</surname><orcid>0000-0002-6956-1100</orcid><order>1</order></author><author><firstname>Michelle</firstname><surname>Edwards</surname><orcid>0000-0001-7432-2828</orcid><order>2</order></author><author><firstname>Delyth</firstname><surname>Price</surname><orcid>0000-0002-4659-2908</orcid><order>3</order></author><author><firstname>Pippa</firstname><surname>Anderson</surname><order>4</order></author><author><firstname>Andrew</firstname><surname>Carson-Stevens</surname><orcid>0000-0002-7580-7699</orcid><order>5</order></author><author><firstname>Mazhar</firstname><surname>Choudhry</surname><orcid>0000-0001-8052-3490</orcid><order>6</order></author><author><firstname>Matthew</firstname><surname>Cooke</surname><orcid>0000-0002-1038-3821</orcid><order>7</order></author><author><firstname>Jeremy</firstname><surname>Dale</surname><orcid>0000-0001-9256-3553</orcid><order>8</order></author><author><firstname>Liam</firstname><surname>Donaldson</surname><orcid>0000-0001-9170-6057</orcid><order>9</order></author><author><firstname>Bridie</firstname><surname>Evans</surname><orcid>0000-0003-0293-0888</orcid><order>10</order></author><author><firstname>Barbara</firstname><surname>Harrington</surname><order>11</order></author><author><firstname>Shaun</firstname><surname>Harris</surname><orcid>0000-0001-7724-6621</orcid><order>12</order></author><author><firstname>Julie</firstname><surname>Hepburn</surname><order>13</order></author><author><firstname>Peter</firstname><surname>Hibbert</surname><orcid>0000-0001-7865-343x</orcid><order>14</order></author><author><firstname>Thomas</firstname><surname>Hughes</surname><orcid>0000-0001-5490-1267</orcid><order>15</order></author><author><firstname>Faris</firstname><surname>Hussain</surname><orcid>0000-0002-7840-6815</orcid><order>16</order></author><author><firstname>Saiful</firstname><surname>Islam</surname><orcid>0000-0003-3182-8487</orcid><order>17</order></author><author><firstname>Rhys</firstname><surname>Pockett</surname><orcid>0000-0003-4135-7383</orcid><order>18</order></author><author><firstname>Alison</firstname><surname>Porter</surname><orcid>0000-0002-3408-7007</orcid><order>19</order></author><author><firstname>Aloysius Niroshan</firstname><surname>Siriwardena</surname><orcid>0000-0003-2484-8201</orcid><order>20</order></author><author><firstname>Helen</firstname><surname>Snooks</surname><orcid>0000-0003-0173-8843</orcid><order>21</order></author><author><firstname>Alan</firstname><surname>Watkins</surname><orcid>0000-0003-3804-1943</orcid><order>22</order></author><author><firstname>Adrian</firstname><surname>Edwards</surname><orcid>0000-0002-6228-4446</orcid><order>23</order></author><author><firstname>Alison</firstname><surname>Cooper</surname><orcid>0000-0001-8660-6721</orcid><order>24</order></author></authors><documents><document><filename>66228__30202__99674c660b284ba5962d3d5a03b0635d.pdf</filename><originalFilename>66228.pdf</originalFilename><uploaded>2024-05-01T12:04:18.1292299</uploaded><type>Output</type><contentLength>3377771</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>https://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling v2 66228 2024-05-01 Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation 128cdedfba6e5e6374fdc85d5c78c428 Pippa Anderson Pippa Anderson true false 6098eddc58e31ac2f3e070cb839faa6a 0000-0003-0293-0888 Bridie Evans Bridie Evans true false 10b1bd08dbad1f2681ff1e527af9f9a3 0000-0001-7724-6621 Shaun Harris Shaun Harris true false 4157d27b800a8357873bdfc9c71bd596 0000-0003-3182-8487 Saiful Islam Saiful Islam true false 8a3882ebcc6a8fb3b2c13fc2ff716bf2 0000-0003-4135-7383 Rhys Pockett Rhys Pockett true false fcc861ec479a79f7fb9befb13192238b 0000-0002-3408-7007 Alison Porter Alison Porter true false ab23c5e0111b88427a155a1f495861d9 0000-0003-0173-8843 Helen Snooks Helen Snooks true false 81fc05c9333d9df41b041157437bcc2f 0000-0003-3804-1943 Alan Watkins Alan Watkins true false 2024-05-01 HSOC BackgroundEmergency healthcare services are under intense pressure to meet increasing patient demands. Many patients presenting to emergency departments could be managed by general practitioners in general practitioner–emergency department service models.ObjectivesTo evaluate the effectiveness, safety, patient experience and system implications of the different general practitioner–emergency department models.DesignMixed-methods realist evaluation.MethodsPhase 1 (2017–8), to understand current practice: rapid realist literature review, national survey and follow-up key informant interviews, national stakeholder event and safety data analysis. Phase 2 (2018–21), to collect and analyse qualitative (observations, interviews) and quantitative data (time series analysis); cost–consequences analysis of routine data; and case site data for ‘marker condition’ analysis from a purposive sample of 13 case sites in England and Wales. Phase 3 (2021–2), to conduct mixed-methods analysis for programme theory and toolkit development.ResultsGeneral practitioners commonly work in emergency departments, but delivery models vary widely in terms of the scope of the general practitioner role and the scale of the general practitioner service. We developed a taxonomy to describe general practitioner–emergency department service models (Integrated with the emergency department service, Parallel within the emergency department, Outside the emergency department on the hospital site) and present a programme theory as principal output of the study to describe how these service models were observed to operate. Routine data were of variable quality, limiting our analysis. Time series analysis demonstrated trends across intervention sites for: increased time spent in the emergency department; increased emergency department attendances and reattendances; and mixed results for hospital admissions. Evidence on patient experience was limited but broadly supportive; we identified department-level processes to optimise the safety of general practitioner–emergency department models.LimitationsThe quality, heterogeneity and extent of routine emergency department data collection during the study period limited the conclusions. Recruitment was limited by criteria for case sites (time series requirements) and individual patients (with ‘marker conditions’). Pandemic and other pressures limited data collection for marker condition analysis. Data collected and analysed were pre pandemic; new approaches such as ‘telephone first’ and their relevance to our findings remains unexplored.ConclusionFindings suggest that general practitioner–emergency department service models do not meet the aim of reducing the overall emergency department waiting times and improving patient flow with limited evidence of cost savings. Qualitative data indicated that general practitioners were often valued as members of the wider emergency department team. We have developed a toolkit, based on our findings, to provide guidance for implementing and delivering general practitioner–emergency department services. Journal Article Health and Social Care Delivery Research 12 10 1 152 National Institute for Health and Care Research 2755-0079 1 4 2024 2024-04-01 10.3310/jwqz5348 COLLEGE NANME Health and Social Care School COLLEGE CODE HSOC Swansea University Not Required NIHR Health and Social Care Delivery Research (HSDR) Programme 2024-06-19T12:44:55.3603745 2024-05-01T09:40:32.6827715 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Freya Davies 0000-0002-6956-1100 1 Michelle Edwards 0000-0001-7432-2828 2 Delyth Price 0000-0002-4659-2908 3 Pippa Anderson 4 Andrew Carson-Stevens 0000-0002-7580-7699 5 Mazhar Choudhry 0000-0001-8052-3490 6 Matthew Cooke 0000-0002-1038-3821 7 Jeremy Dale 0000-0001-9256-3553 8 Liam Donaldson 0000-0001-9170-6057 9 Bridie Evans 0000-0003-0293-0888 10 Barbara Harrington 11 Shaun Harris 0000-0001-7724-6621 12 Julie Hepburn 13 Peter Hibbert 0000-0001-7865-343x 14 Thomas Hughes 0000-0001-5490-1267 15 Faris Hussain 0000-0002-7840-6815 16 Saiful Islam 0000-0003-3182-8487 17 Rhys Pockett 0000-0003-4135-7383 18 Alison Porter 0000-0002-3408-7007 19 Aloysius Niroshan Siriwardena 0000-0003-2484-8201 20 Helen Snooks 0000-0003-0173-8843 21 Alan Watkins 0000-0003-3804-1943 22 Adrian Edwards 0000-0002-6228-4446 23 Alison Cooper 0000-0001-8660-6721 24 66228__30202__99674c660b284ba5962d3d5a03b0635d.pdf 66228.pdf 2024-05-01T12:04:18.1292299 Output 3377771 application/pdf Version of Record true This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence. true eng https://creativecommons.org/licenses/by/4.0/
title Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation
spellingShingle Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation
Pippa Anderson
Bridie Evans
Shaun Harris
Saiful Islam
Rhys Pockett
Alison Porter
Helen Snooks
Alan Watkins
title_short Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation
title_full Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation
title_fullStr Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation
title_full_unstemmed Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation
title_sort Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation
author_id_str_mv 128cdedfba6e5e6374fdc85d5c78c428
6098eddc58e31ac2f3e070cb839faa6a
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4157d27b800a8357873bdfc9c71bd596
8a3882ebcc6a8fb3b2c13fc2ff716bf2
fcc861ec479a79f7fb9befb13192238b
ab23c5e0111b88427a155a1f495861d9
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author_id_fullname_str_mv 128cdedfba6e5e6374fdc85d5c78c428_***_Pippa Anderson
6098eddc58e31ac2f3e070cb839faa6a_***_Bridie Evans
10b1bd08dbad1f2681ff1e527af9f9a3_***_Shaun Harris
4157d27b800a8357873bdfc9c71bd596_***_Saiful Islam
8a3882ebcc6a8fb3b2c13fc2ff716bf2_***_Rhys Pockett
fcc861ec479a79f7fb9befb13192238b_***_Alison Porter
ab23c5e0111b88427a155a1f495861d9_***_Helen Snooks
81fc05c9333d9df41b041157437bcc2f_***_Alan Watkins
author Pippa Anderson
Bridie Evans
Shaun Harris
Saiful Islam
Rhys Pockett
Alison Porter
Helen Snooks
Alan Watkins
author2 Freya Davies
Michelle Edwards
Delyth Price
Pippa Anderson
Andrew Carson-Stevens
Mazhar Choudhry
Matthew Cooke
Jeremy Dale
Liam Donaldson
Bridie Evans
Barbara Harrington
Shaun Harris
Julie Hepburn
Peter Hibbert
Thomas Hughes
Faris Hussain
Saiful Islam
Rhys Pockett
Alison Porter
Aloysius Niroshan Siriwardena
Helen Snooks
Alan Watkins
Adrian Edwards
Alison Cooper
format Journal article
container_title Health and Social Care Delivery Research
container_volume 12
container_issue 10
container_start_page 1
publishDate 2024
institution Swansea University
issn 2755-0079
doi_str_mv 10.3310/jwqz5348
publisher National Institute for Health and Care Research
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description BackgroundEmergency healthcare services are under intense pressure to meet increasing patient demands. Many patients presenting to emergency departments could be managed by general practitioners in general practitioner–emergency department service models.ObjectivesTo evaluate the effectiveness, safety, patient experience and system implications of the different general practitioner–emergency department models.DesignMixed-methods realist evaluation.MethodsPhase 1 (2017–8), to understand current practice: rapid realist literature review, national survey and follow-up key informant interviews, national stakeholder event and safety data analysis. Phase 2 (2018–21), to collect and analyse qualitative (observations, interviews) and quantitative data (time series analysis); cost–consequences analysis of routine data; and case site data for ‘marker condition’ analysis from a purposive sample of 13 case sites in England and Wales. Phase 3 (2021–2), to conduct mixed-methods analysis for programme theory and toolkit development.ResultsGeneral practitioners commonly work in emergency departments, but delivery models vary widely in terms of the scope of the general practitioner role and the scale of the general practitioner service. We developed a taxonomy to describe general practitioner–emergency department service models (Integrated with the emergency department service, Parallel within the emergency department, Outside the emergency department on the hospital site) and present a programme theory as principal output of the study to describe how these service models were observed to operate. Routine data were of variable quality, limiting our analysis. Time series analysis demonstrated trends across intervention sites for: increased time spent in the emergency department; increased emergency department attendances and reattendances; and mixed results for hospital admissions. Evidence on patient experience was limited but broadly supportive; we identified department-level processes to optimise the safety of general practitioner–emergency department models.LimitationsThe quality, heterogeneity and extent of routine emergency department data collection during the study period limited the conclusions. Recruitment was limited by criteria for case sites (time series requirements) and individual patients (with ‘marker conditions’). Pandemic and other pressures limited data collection for marker condition analysis. Data collected and analysed were pre pandemic; new approaches such as ‘telephone first’ and their relevance to our findings remains unexplored.ConclusionFindings suggest that general practitioner–emergency department service models do not meet the aim of reducing the overall emergency department waiting times and improving patient flow with limited evidence of cost savings. Qualitative data indicated that general practitioners were often valued as members of the wider emergency department team. We have developed a toolkit, based on our findings, to provide guidance for implementing and delivering general practitioner–emergency department services.
published_date 2024-04-01T12:44:54Z
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score 11.037166

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