ABSTRACT
RATIONALE: Offering a primary care service that can provide good quality primary care at emergency departments may reduce pressure on usual emergency department (ED) services. AIMS AND OBJECTIVES: To evaluate the acceptability, satisfaction, and potential impacts of a co-located primary care service at an emergency department. METHODS: This is a prospective feasibility study and service evaluation comprising a narrative summary of activity, satisfaction, well-being, and safety, and comparisons of wait times for ED services by patient category ('minor', 'majors', 'paediatric' or 'resus') before and during the service operation. Patients and staff were asked using semistructured interview topic guides about service perception, well-being, representation within 48 h, safety concerns, and/or satisfaction. Wait times for patient categories in usual ED care service were in secondary care electronic records. Pathway changes were captured under primary care electronic records. RESULTS: Approximately 96% of general practitioner streaming and treatment (GPST) patients were seen within 1 h. There was a statistically significant reduction in ED patients with minor injuries or illnesses waiting >4 h for admission or discharge 'breaches' during the 3 months that GPST was operating compared with the previous 3 months (p ≤ 0.005). Wait times for other ED services did not significantly improve. A total of 769 walk-in patients received GPST consultation and 661 (86%) needed no further ED intervention. Fast discharge was a major determinant of patient satisfaction. No staff expressed dissatisfaction, but some suggested possible improvements in eligibility criteria and built environment design features. CONCLUSION: Provision of GPST correlated with shorter waits for discharge from ED. Patient and staff experiences of GPST were positive.
Subject(s)
General Practitioners , Humans , Child , Prospective Studies , Feasibility Studies , Emergency Service, Hospital , Quality of Health Care , Patient SatisfactionABSTRACT
The aim of the study was to compare the efficacy of the inhaled long-acting beta2-agonists eformoterol and salmeterol when added to existing inhaled corticosteroid (ICS) therapy in symptomatic asthmatic children. This randomized, 12-week, parallel-group study, performed in a primary care setting, included 156 children and adolescents (aged 6-17 years) with moderate persistent asthma. Patients were randomized to open-label eformoterol (Oxis) Turbohaler 9 microg (delivered dose) or salmeterol Accuhaler 50 microg, both b.i.d, added to current ICS. Assessments included: changes in daytime reliever beta2-agonist therapy (primary variable), total 24-h reliever use, lung function, clinic and diary symptom scores, patient and carer health-related quality of life (HRQL) and adverse events. Daytime reliever use decreased significantly (p < 0.001) from baseline by 65% and 52%, respectively in the eformoterol and salmeterol treatment groups. Compared with salmeterol, eformoterol produced a greater decrease in daytime (-0.46 inhalations/day; p = 0.081) and 24-h (-0.70 inhalations/day; p = 0.043) reliever use. The percentage of patients who did not require any reliever medication during the study was significantly higher in the eformoterol group (p < 0.05 vs. salmeterol at weeks 8 and 12). Clinic and diary card peak expiratory flow and symptom measures all improved from baseline in both treatment arms. There was a significantly greater effect in favour of eformoterol for the reduction in clinic-assessed overall night-time symptoms (p < 0.05 vs. salmeterol). Clinically relevant improvements in patient-assessed HRQL occurred during treatment with eformoterol and salmeterol, but carer-assessed HRQL was improved to a clinically relevant extent, only with eformoterol. Both treatments were well tolerated. In children and adolescents with moderate persistent asthma, add-on therapy with eformoterol was well tolerated and at least as effective as salmeterol.
Subject(s)
Adrenergic beta-Agonists/administration & dosage , Albuterol/analogs & derivatives , Albuterol/administration & dosage , Asthma/drug therapy , Ethanolamines/administration & dosage , Administration, Inhalation , Adolescent , Adrenal Cortex Hormones/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Caregivers , Child , Female , Formoterol Fumarate , Humans , Male , Powders/administration & dosage , Pulmonary Ventilation , Quality of Life , Salmeterol Xinafoate , Treatment OutcomeABSTRACT
A GP practice set up a new system of assessing patients, with an emphasis on appropriate immediate need. The aim is to speed up treatment and reduce inappropriate accident and emergency admissions. A new role of community paramedic on loan from the ambulance trust was a vital part of the team. The first eight months dramatically cut accident and emergency admissions and sped up category A response times.
Subject(s)
Emergency Medical Services/organization & administration , Family Practice/organization & administration , Patient Care Team , Triage/organization & administration , Emergency Medical Technicians/education , Emergency Medical Technicians/standards , England , Humans , State Medicine , TimeABSTRACT
Health care technology is continuously moving forward with great advances in all fields of medicine. The way in which health care is delivered has been stuck in a primary care/secondary care model, which is failing to meet patients' needs. Existing structures are inefficient because they do not maximise use of skills. A new way of delivering services is proposed using an intermediate level specialist--a general practitioner with a special clinical interest (GPSCI), to increase access at a location close to the patient while giving support to the wider primary health community. We explore how the role of GPSCI might work using the field of respiratory medicine as an exemplar. The concept is transferable to other therapeutic areas.
