Evidence map›Paper›PMID 29748341›Full record

Observational studyBMJ open2018

General practitioners providing non-urgent care in emergency department: a natural experiment.

Olalekan A Uthman, Clare Walker, Sudakshina Lahiri, David Jenkinson, Victor Adekanmbi, Wendy Robertson, Aileen Clarke

Abstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Observational
  3. Observational
  4. Article
  5. Article
  6. Review
  7. Article
  8. Article
  9. Article
  10. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Olalekan A UthmanDivision of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK.
Clare WalkerDivision of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK.
Sudakshina LahiriInstitute of Digital Healthcare, WMG, The University of Warwick, Coventry, UK.
David JenkinsonDivision of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK.
Victor AdekanmbiDivision of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK.
Wendy RobertsonDivision of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK.
Aileen ClarkeDivision of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK.

Funding

Department of Health
6 · The paper itself

Abstract

objectiveTo examine whether care provided by general practitioners (GPs) to non-urgent patients in the emergency department differs significantly from care provided by usual accident and emergency (A&E) staff in terms of process outcomes and A&E clinical quality indicators.

designPropensity score matched cohort study.

settingGPs in A&E colocated within the University Hospitals Coventry and Warwickshire NHS Trust between May 2015 and March 2016.

participantsNon-urgent attendances visits to the A&E department. MAIN OUTCOMES: Process outcomes (any investigation, any blood investigation, any radiological investigation, any intervention, admission and referrals) and A&E clinical indicators (spent 4 hours plus, left without being seen and 7-day reattendance).

resultsA total of 5426 patients seen by GPs in A&E were matched with 10 852 patients seen by emergency physicians (ratio 1:2). Compared with standard care in A&E, GPs in A&E significantly: admitted fewer patients (risk ratio (RR) 0.28, 95% CI 0.25 to 0.31), referred fewer patients to other specialists (RR 0.31, 95% CI 0.24 to 0.40), ordered fewer radiological investigations (RR 0.38, 95% CI 0.34 to 0.42), ordered fewer blood tests (0.57, 95% CI 0.52 to 0.61) and ordered fewer investigations (0.93, 95% CI 0.90 to 0.96). However, they intervened more, offered more primary care follow-up (RR 1.78, 95% CI 1.67 to 1.89) and referred more patients to outpatient and other A&E clinics (RR 2.29, 95% CI 2.10 to 2.49). Patients seen by GPs in A&E were on average less likely to spend 4 hours plus in A&E (RR 0.37, 95% CI 0.30 to 0.45) compared with standard care in A&E. There was no difference in reattendance after 7 days (RR 0.96, 95% CI 0.84 to 1.09).

conclusionGPs in A&E tended to manage self-reporting minor cases with fewer resources than standard care in A&E, without increasing reattendance rates.

Indexed as

AdultCohort StudiesEmergency Service, HospitalFemaleHospitalizationHumansMaleOdds RatioPrimary Health CarePropensity ScoreReferral and ConsultationTime Factorsfour hour delaygeneral practitionersnatural experimentpropensity score

Identifiers

PMID29748341
PMCPMC5950695

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.