Outcome measured | Key findings from the statistical analysis13 | Explored with the qualitative data13 |
ED attendances over time (2010–2018) | No evidence of reduction in attendances, with increased attendances in all intervention sites where change could be assessed with confidence (some statistically significant). | Perception at some sites that increases in primary care demand have been triggered by the visibility, accessibility and local awareness of the GP-ED model. |
ED reattendances within 28 days | Controls all show increases over time. At intervention sites, all that could be calculated show increased reattendances post intervention except for integrated-2 (statistically significant decrease). | Integrated-2 was a very small ED and saw a limited range of patients with more unwell patients being taken to an alternative hospital. (After the study period this ED was downgraded to an urgent care centre.) |
Average time in the ED | Increased at all 3 control sites during study period and most intervention sites. Two intervention sites (outside-3, parallel-2) identified with evidence of reversal in upward trends in average time in the ED. | There was a new frailty unit at outside-3 introduced at the same time as the GP-ED model. Note this site also showed a negative trend for admissions. |
Investigation use | Mixed picture of investigation use from control sites (flat or upward trends). Also, a mixed picture within each model. Two sites of interest showing statistically significant decreases in investigations post intervention (parallel-3, parallel-4). | At parallel-4 GPs had no access to investigations. At parallel-3 there was a structured pathway for redirecting patients to community primary care. GP-ED model saw only small proportion of overall ED attendances limiting potential impact. |
Admissions | All 3 control sites have upward trends, mixed picture across intervention sites. Statistically significant post intervention changes identified at two sites. Parallel-4 showed a reversal of direction of trend from increasing to decreasing admissions. Integrated-1 showed increased admissions post intervention. | At parallel-4, ‘the GP role’ was supported and staff gave examples of GPs managing paediatric patients without the need for admission. At integrated-1, staff perceived that demand was increasing due to new housing developments in the area. |
Reproduced with permission from Davies et al, NIHR Journals Library. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/.
GP, general practitioner.