Randomised controlled trial of general practitioner versus usual medical care in an urban accident and emergency department : process, outcome, and comparative cost.
To see whether care provided by general practitioners to non-emergency patients in an accident and emergency department differs significantly from care by usual accident and emergency staff in terms of process, outcome, and comparative cost.
Design-A randomised controlled trial
Setting-A busy inner city hospital's accident and emergency department which employed three local general practitioners on a sessional basis.
Patients-All new attenders categorised by the triage system as « semiurgent » or « delay acceptable. » 66% of all attenders were eligible for inclusion.
Main outcome measures-Numbers of patients undergoing investigation, referral, or prescription ; types of disposal ; consultation satisfaction scores ; reattendance to accident and emergency department within 30 days of index visit ; health status at one month ; comparative cost differences.
4684 patients participated.
For semiurgent patients, by comparison with usual accident and emergency staff, general practitioners investigated fewer patients (relative difference 20% ; 95% confidence interval 16% to 25%), referred to other hospital services less often (39% ; 28% to 47%), admitted fewer patients (45% ; 32% to 56%), and prescribed more often (41% ; 30% to 54%). A similar trend was found for patients categorised as delay acceptable and (in a separate analysis) by presenting complaint category. 393 (17%) patients who had been seen by general practitioner staff reattended the depa...
Mots-clés Pascal : Médecin généraliste, Soin, Urgence, Service hospitalier, Coût, Economie santé, Homme, Etude comparative, Ville
Mots-clés Pascal anglais : General practitioner, Care, Emergency, Hospital ward, Costs, Health economy, Human, Comparative study, Town
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0271525
Code Inist : 002B30A04B. Création : 199608.