The findings contradict previous studies that only relied on data analysis, writes Antony Scholefield at Australian Doctor
The first Australian study to place GPs in emergency departments has concluded that at least 20% of ED presentations could be managed in general practice, many more than previous estimates.
The authors say other research on the subject — a key issue for policymakers trying to control healthcare costs — is “potentially invalid” because none involved real GP assessment of patients.
Those studies relied on data analysis of hospital triage records or diagnoses.
In the new study, researchers from the University of WA asked 14 GPs to sit in on emergency shifts at four different hospitals.
Between them, the GPs assessed 506 patients who were expected to be discharged home.
They determined that 54% could have been handled in primary care, along with a further 26% if general practice had extra resources such as onsite radiology.
And hospital doctors had no objections, with the researchers finding “very good agreement” between GPs and the ED physicians on the same shift.
Extrapolating to the broader ED cohort, the researchers said 20-40% of ED presentations could be managed in general practice.
“If all of these… presentations in WA could be diverted into primary care, this would represent a potential reduction of between 200,000 and 400,000 ED presentations per year,” they said.
The broad range of estimates was to account for the “non-random” sampling method of choosing likely patients for GP assessment, they said.
“The interviewed cohort was an opportunistic, non-random sample. This was intentional in order to minimise disruption to normal patient care in the EDs,” the researchers wrote in Emergency Medicine Australasia.
They compared the results to the methods other studies had used to determine primary care-type presentations.
These were often limited to patients assessed as 3, 4 or 5 on the Australasian Triage Scale (ATS), or based on a list of ‘GP-type diagnoses’.
However, the new study found that about 30% of ATS category 2 patients seen by the GPs were considered manageable in general practice.
They also found that only 47% of patients assessed as GP-manageable had a diagnosis on the list used in previous research.
“These findings suggest that previous criteria used to identify the burden of primary care-type ED presentations in EDs are not supported by direct GP clinical assessment of ED patients,” the authors wrote.
“Any conclusions made in previous studies concerning the volume of primary care-type ED presentations are potentially invalid.
“A unifying feature of these differing methods is that they are indirect measures; none have been trialled alongside the clinical judgement of a GP.
“It is reasonable to suggest that a valid method to determine if a patient is a GP-type patient would be the clinical opinion of a GP.”
Some previous studies assumed that any patient referred by a GP was not manageable in primary care.
However, the new study found that 13% of patients designated as such had been referred to emergency by another GP.
“This may reflect variations in skills, resources, or threshold for referral among GPs in the community,” the researchers said.
