RT Journal Article
SR Electronic
T1 Addition of a general practitioner to the accident and emergency department: a cost-effective innovation in emergency care
JF Emergency Medicine Journal
JO Emerg Med J
FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine
SP 192
OP 196
DO 10.1136/emj.2010.101949
VO 29
IS 3
A1 Judith E Bosmans
A1 A Joan Boeke
A1 Marguerite E van Randwijck-Jacobze
A1 Sietske M Grol
A1 Mark H Kramer
A1 Henriëtte E van der Horst
A1 Maurits W van Tulder
YR 2012
UL http://emj.bmj.com/content/29/3/192.abstract
AB Background Many patients visit the accident and emergency department (AED) on their own initiative, although their medical problem can be adequately treated by a general practitioner (GP).Objective To evaluate the cost-effectiveness of addition of a GP to the AED (new care method) in comparison with usual care (usual care method).Methods This study followed a before/after design. Patients attending the AED without a referral on weekdays from 10:00 to 17:00 were invited to participate. Main outcome measures were process time, patient satisfaction and number of correct diagnoses. Costs were measured from a societal perspective. Bootstrapping was used to estimate uncertainty around differences in costs and incremental cost-effectiveness ratios. Cost-effectiveness planes and acceptability curves were presented.Results Addition of a GP to the AED resulted in significantly lower process time, significantly higher patient satisfaction and no statistically significant difference in the number of correct diagnoses. Total costs per patient were €217 in the new care period and €288 in the usual care period (mean difference −€71, 95% CI −121 to −23). The cost-effectiveness analysis showed that the new care method was dominant (more effective, less expensive) in comparison with the usual care method for process time and patient satisfaction. The new care method was considered cost-effective in comparison with the usual care method for ceiling ratios between €0 and €1363 for the number of correct diagnoses.Conclusion The new care method consisting of addition of a GP to the AED is cost-effective in comparison with usual care for all outcome parameters measured.