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- Drawing comparisons between co-located primary care and emergency department services within adult and paediatric care
We read with interest this paper by Leigh and colleagues,1 which sparked intrigue at the mention of limited supportive data from other studies. This enticed us to explore other papers regarding this topic in order to identify novel or unique features of the current study such that they could be reproduced. Upon doing so, we noticed that the common denominator appeared to be the differentiation between paediatric emergency department (ED) and adult ED services, with the former having notable beneficial outcomes compared to the limited findings from adult services.2-5
On analysing the literature referenced from the current study we found that those conducted in a general ED setting had minimal benefit from the adjunct of a GP to the service. This was reinforced by our exploration of multiple studies that specifically focused on children’s ED services.6-9 These demonstrated significant increases in cost effectiveness and efficiency including reduced length of stay and admission rates. We recognise that this may result from parents being more likely to bring their child to the ED with non-urgent ailments.10 This coincides with findings from the current study that costs were reduced by almost 60% for children under 6 months.
Consideration should be given to the time frame of GP availability. The current study explicitly specifies the time period as 2pm-10pm. By and large, no mention is made of this in...
Show MoreCompeting Interests: None declared. - Antibiotic prescribing by GPs in the emergency departmentThe authors are to be congratulated on having the inspiration to use the “natural experiment” of patients being diverted to the emergency department (ED) when a GP was not available. However, I wonder if, first, this is typical of most GP in ED services and second, if missing data may have reduced the reliability of the findings.The comparator group were patients referred to the ED when a GP was not available. There were 5737 patients in the ED group and 8707 in the GP group, meaning that the GP service was unavailable for 39.7% of presentations. That is a very large proportion. How does it compare with services elsewhere in the country? I suspect that this service is not typical of the rest of the country so the generalisability of the findings are in doubt.Eighteen per cent of ED group were excluded from the study because of missing data while only 3% of GP group were. The missing data may have nothing to do with the quality of care and might just represent different patterns of work and pressure but even so, despite adjustment for confounders, this huge differential exclusion reduces the reliability of comparing outcomes of the two services.Competing Interests: None declared.