Scant evidence for benefits of primary care co-located in emergency departments, says EMJ
April 13 2015
There is little evidence to show any benefits of locating primary care-focused unscheduled care centres (UCCs) within hospital emergency departments (EDs), a study has concluded.
Not only are UCCs associated with an increase in attendance, possibly due to provider-induced demand, but the evidence for improved throughput is poor, said the researchers in the Emergency Medicine Journal.
A search of papers on the subject between 1980 and 2015 identified 20 papers suitable for inclusion in the review, with four from England, eight from the Netherlands and the others involving Australia, Ireland, Spain, Sweden and Switzerland.
“The majority of studies described the addition of a GP to manage minor health conditions, with direct substitution for usual ED staff only explicitly described in one paper,” said the researchers. “Much of the impetus for implementing co-located UCCs stems from an accepted theoretical basis supported by individual examples of success in other settings. The evidence base, however, suggests that the expected benefits of the introduction of such a service are not a given, with variable outcomes reported.”
In addition to the “unexpected consequence of a paradoxical increase in demand driven by co-locating services that are meant to reduce such demand”, the researchers noted that “theoretical cost savings are not as expected when subject to closer scrutiny, particularly as most reported savings are based on marginal costs without consideration of capital or indirect expenditure.”
The researchers found scant evidence for a model that is cost neutral across the health community. “Any proposed model, therefore, requires robust evaluation before implementation.”
In an accompanying editorial , Professor Derek Burke, of Sheffield Children’s Hospital NHS Foundation Trust, said that before any further major change is contemplated, “we must be absolutely clear about what we are aiming for.” Detailed analyses of current patient flows, including between the various access points, must also be carried out and the impact of changes monitored and rigorously evaluated.
“Failure to rigorously plan changes in service provision at best will lead to an expensive and disruptive trial-and-error approach to resource allocation,” he said. “Finally, we must come to accept that unscheduled care is now a consumer item and seen by users as being no different from the availability of 24 hour shopping. In this age of consumer-based healthcare provision, not considering the consumer’s view is a recipe for failure.”