Family medicine in the emergency department, Jordan

Increasing demands on health services have resulted in a number of innovations in delivering care. In November 2005, a unique new care model was started in the emergency department (A&E) of Al-Bashir Hospital, the largest government hospital in Amman, Jordan. Family medicine physicians (specialists and residents) started working and are still working in newly added clinics to the A&E department, providing 24-hour primary care services to non-urgent patients; ‘inappropriate attenders’, on a non-appointment basis, with the aim of decreasing the pressure on the overburdened A&E department.1

In 2006 the total number of patients was 99 286 (272/day) in 2007, 102 127 (280/day), and in 2008 total 143 186 (392/day), a 40% increase. In 2009 the number of patients continued to rise, reaching a maximum of 649/day during the month of May. In October 2009 a nominal fee was re-established, that led to a dramatic decrease in the number of patients, falling to 8126 (271/day) in November. By 2010 the total number was 111 962 (307/day), a 37.2% reduction from 2009. In 2011 the total was 116 862 (320/day).2

Research from several countries support the new role of family medicine physicians in the A&E department. Boeke et al, in Amsterdam, the Netherlands, concluded that the new care method that combined the involvement of a GP in the A&E department and allocation of patients by triage to either the GP or the A&E physician, resulted in greater patient satisfaction and maintained the quality of care, with fewer additional examinations.’.3

Dale and his coworkers at King’s College School of Medicine and Dentistry have been researching the demand for ‘emergency’ primary care since 1988. They concluded that employing GPs in the A&E departments to manage patients with primary care needs reduced rates of investigation, prescription, and referral when compared with hospital doctors.1

• © British Journal of General Practice 2013