ABSTRACT
Study Objectives: To evaluate the impact of a general practitioner (GP) programme on low-acuity patient load (patient acuity scale P3 or P4) presenting at a participating emergency department (ED) of a regional public hospital in Singapore. Secondly, to analyse the appropriateness of participating GPs' referrals to ED based on programme criteria. Study Design/Methods: This is a descriptive observational study of a regionally implemented, government funded programme called GPFirst, from 2014 to 2019 (pre-COVID). In this programme, a patient attended to at a GPFirst clinic and subsequently referred to ED, will qualify for an ED attendance fee discount. Data are retrospectively collected from referral letters of GPs participating in the programme and the hospital's electronic health record system. Results/Findings: During the study period, 207 GPs were progressively enrolled. The annual number of low acuity attendances reduced from 62,213 in 2013 (pre-GPFirst) to 53,480 in 2019 even though the annual number of ED attendances increased gradually from 138,784 in 2014 to 141,072 in year 2019. Moreover, the annual proportion of low-acuity, self-referred cases decreased from 63.4% (39,425) in 2013 to 57.1% (30,528) in year 2019. The annual percentage of GPFirst referrals to the ED which meet referral appropriateness criteria increased from 94.5% (FY2014) to 97.6% (FY2019) and 98.0% (FY2020). Overall, the roll out of GPFirst appears to coincide with a reduction in low acuity patient load without compromising the appropriateness of GP referrals to the ED. Conclusion(s): A multi-faceted regional programme which included campaigned public education, regular GP continuous education, a supportive administrative team and financial incentive for patients, is able to reduce low acuity attendances. An ecosystem emerges which contributes to GPFirst's success. Further research is needed to evaluate safety and the effects of scaling this programme to a national level. No, authors do not have interests to disclose Copyright © 2022