Patient and care characteristics of self-referrals treated by the general practitioner cooperative at emergency-care-access-points in the Netherlands

Abstract

BackgroundIn the Netherlands, out-of-hours primary care is provided in general practitioner-cooperatives (GPCs). These are increasingly located on site and in collaboration with emergency departments of hospitals (ED). At such sites, also called emergency-care-access-points (ECAP), the GPC is generally responsible for the triage and treatment of self-referrals who used to attend the ED. To evaluate the effects and safety of this novel organisation, we studied the characteristics and the quality of care given by GPCs to self-referrals at ECAPs.MethodsRetrospective analysis (August 2011–January 2012) of 783 records of self-referred patients at three Dutch GPCs in an ECAP. This was supplemented with a retrospective analysis of patient records during a follow-up period of three-months to asses safety.ResultsPatient-characteristics: 59% was male, 46% aged between 16–45 years and 59% trauma-related. Most cases (95%) were triaged low-urgent. None received the highest urgency-category. Quality: The triage outcome was correct in 79%, underestimated in 12% and overestimated in 9%. After GP consultation 20% were referred to the ED, mostly for radio-diagnostics. Of the referrals to secondary care, 98% were according to common medical practice. Thirty percent had a follow-up contact, mostly with their own general practitioner, seldom with the ED. Complications, all non-severe, were registered in 3.2%; 0.4% were possibly preventable.ConclusionsSelf-referred patients at an ECAP are mostly trauma related, low-urgent and male patients. The majority could be treated by the GPC without subsequent referral to the ED. Care given at the GPC is reasonably efficient and safe. Triage and treatment of self-referrals by the GPC at ECAPs might offer opportunities for other countries facing problems with inappropriate emergency department visits.

Does X‐ray imaging by GPC at emergency care access points in the Netherlands change patient flow and reduce ED crowding? A cohort study

“…We did not look at patients who received no diagnostic imaging and where injuries could have been missed. Nevertheless, previous studies showed that the treatment of patients at the GPC maintained the safety and quality of care, and missed injuries were equal at the ED and GPC . The observational design has the risk of not recognizing factors outside the ECAP that might have contributed to the results.…”

“…Nevertheless, multiple studies have shown the opposite. Implementations of ECAPs resulted in fewer X‐ray examinations, also when this was available for GPCs . Furthermore, there was no difference in risk assessment and indications for X‐ray requests between access and no access to radiology for GPCs …”

“…Implementations of ECAPs resulted in fewer X-ray examinations, also when this was available for GPCs. [18][19][20] Furthermore, there was no difference in risk assessment and indications for X-ray requests between access and no access to radiology for GPCs. 11 With increasing numbers of GPCs in Europe and multiple countries facing the problem of ED crowding and nonurgent selfreferring patients, our results could be of importance internationally.…”

“…Nevertheless, previous studies showed that the treatment of patients at the GPC maintained the safety and quality of care, and missed injuries were equal at the ED and GPC. 18,19 The observational design has the risk of not recognizing factors outside the ECAP that might have contributed to the results. Since this was a naturally occurring implementation, there was no before-after study.…”

Emergency department crowding: why do patients walk-in?

“…As concerns primary care physicians' accessibility in modern healthcare world, several authors have advocated the efficiency of primary health-care facilities located near EDs to alleviate ED attendance with patients in need of primary care. This method has been experienced in some location in Belgium and Europe with hopeful and reliable results [6,9,12,16,[24][25][26][27][28][29].…”