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  1. Mary Dawood, Associate Editor

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“People attend ED because they choose to”

Emergency Department (ED) attendances over the past decade have been rising both in western countries as well as in the developing world. One school of thought attributes this to an increase in patients who would be better managed in primary care. Various initiatives have been put in place in the UK in recent years which include hospital based unscheduled care services staffed by GP's and other primary care clinicians aimed at diverting patients away from the ED. You could be forgiven for questioning the success of these initiatives if your ED is crowded most of the time.

On this note you might then be interested to read both the editorial by Derek Burke as well as a review of the literature by Ramlackhan and colleagues from Sheffield relating to the impact of GP delivered hospital based unscheduled care services. Their study focused particularly on process outcomes, cost effectiveness, and patient satisfaction. They found a paradoxical increase in attendance and the evidence for improved output to be poor, moreover there was no evidence of improved patient satisfaction. In one study patients actually expressed a preference for care in an ED as opposed to a new co located …

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