عنوان

Primary care in accident and emergency departments :

شماره

TLets808476

عنوان اصلي

Primary care in accident and emergency departments :

نام عام مواد

[Thesis]

نام نخستين پديدآور

Dale, Jeremy

عنوان اصلي به قلم نويسنده ديگر

the cost effectiveness and applicability of a new model of care

نام ساير پديدآوران

Roberts, J.

نام ناشر، پخش کننده و غيره

London School of Hygiene & Tropical Medicine

تاریخ نشرو بخش و غیره

1998

جزئيات پايان نامه و نوع درجه آن

Thesis (Ph.D.)

امتياز متن

1998

متن يادداشت

The thesis describes the development, research and evaluation of the applicability of a new model of care that involves GPs being employed on a sessional basis in A&E departments to treat patients attending with primary care needs. The main aim of the study was to research its cost and clinical effectiveness. A multi-faceted approach was taken to include consideration of patients' needs and preferences, professional concerns, organisational and structural issues within the health service, and planning and policy issues. Clinical, sociological, epidemiological, and economic perspectives are drawn upon, reflecting the context of the service development and to provide a firm base for discussion about the generalisability and applicability of the findings. The first two chapters provide a detailed review of the epidemiological, sociological, clinical, and organisational literature relating to the primary care/A&E interface. The incentives and disincentives that may act to increase or reduce demand and supply are explored, in addition to issues relating to the 'appropriateness' of demand, the organisational culture of A&E departments, and strategies used to curtail or cope with demand. The demand for primary care at A&E departments appears to cross national boundaries and hence, literature from other countries (particularly the USA) is included and its applicability to the UK considered. Relevant literature relating to the quality of A&E care, patient satisfaction, and the costing of care is also discussed. The main study was a prospective controlled trial that was conducted at King's College Hospital. This compared process variables, clinical outcome and costs of 'primary care' consultations performed by senior house officers (SHOs), registrars, and general practitioners working three-hour sessions in A&E. A new system of nurse triage was implemented to allow the prospective identification of patients presenting with primary care needs. A total of 27 SHOs, three registrars and one senior registrar were included, and the patient sample comprised 1702 patients seen by GPs, 2382 by SHOs, and 557 by registrars or the senior registrar. GPs were found to practice considerably less interventionist care than A&E medical staff, and the resource implications were substantial. The findings are discussed critically, and their applicability is considered drawing on empirical data from recent evaluations of A&E Primary Care Service developments in other parts of London. The policy and service implications of the study are considered and further research needs identified.

موضوع مستند نشده

Health services & community care services

مستند نام اشخاص تاييد نشده

London School of Hygiene & Tropical Medicine

مستند نام اشخاص تاييد نشده

Roberts, J.

مستند نام تنالگان تاييد نشده

London School of Hygiene & Tropical Medicine

شماره بازیابی

http://doi.org/10.17037/PUBS.00682264

نام الکترونيکي

فرمت انتشار

p

نوع ماده

[Thesis]

کد کاربرگه

276903

سطح دسترسي

a

تكميل شده

Y