General practice

Cost effectiveness of treating primary care patients in accident and emergency: a comparison between general practitioners, senior house officers, and registrars

BMJ 1996; 312 doi: 10.1136/bmj.312.7042.1340 (Published 25 May 1996)
Cite this as: BMJ 1996;312:1340
  1. Jeremy Dale, senior lecturer in primary carea,
  2. Henrietta Lang, researcherb,
  3. Jennifer A Roberts, senior lecturer in health economicsb,
  4. Judith Green, researchera,
  5. Edward Glucksman, consultantc
  1. a Department of General Practice and Primary Care and Department of Accident and Emergency Medicine, King's College School of Medicine and Dentistry, London SE5 9JP
  2. b Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  3. c Accident and Emergency Department, King's College Hospital, London SE5 9RS
  1. Correspondence to: Dr Dale.
  • Accepted 12 April 1996

Abstract

Objectives: To compare outcome and costs of general practitioners, senior house officers, and registrars treating patients who attended accident and emergency department with problems assessed at triage as being of primary care type.

Design: Prospective intervention study which was later costed.

Setting: Inner city accident and emergency department in south east London.

Subjects: 4641 patients presenting with primary care problems: 1702 were seen by general practitioners, 2382 by senior house officers, and 557 by registrars.

Main outcome measures: Satisfaction and outcome assessed in subsample of 565 patients 7-10 days after hospital attendance and aggregate costs of hospital care provided.

Results: Most patients expressed high levels of satisfaction with clinical assessment (430/562 (77%)), treatment (418/557 (75%)), and consulting doctor's manner (434/492 (88%)). Patients' reported outcome and use of general practice in 7-10 days after attendance were similar: 206/241 (85%), 224/263 (85%), and 52/59 (88%) of those seen by general practitioners, senior house officers, and registrars respectively were fully recovered or improving (χ2=0.35, P=0.840), while 48/240 (20%), 48/268 (18%), and 12/57 (21%) respectively consulted a general practitioner or practice nurse (χ2=0.51, P=0.774). Excluding costs of admissions, the average costs per case were £19.30, £17.97, and £11.70 for senior house officers, registrars, and general practitioners respectively. With cost of admissions included, these costs were £58.25, £44.68, and £32.30 respectively.

Conclusion: Management of patients with primary care needs in accident and emergency department by general practitioners reduced costs with no apparent detrimental effect on outcome. These results support new role for general practitioners.

Key messages

  • We compared the costs and outcomes of general practitioners and hospital doctors treating patients with primary care problems who attended an accident and emergency department

  • There were no significant differences between the types of doctor in terms of patients' satisfaction and clinical outcome

  • General practitioners provided care more cheaply than did the hospital doctors, reflecting their less frequent requests for investigations and referrals

  • Employing general practitioners in accident and emergency departments offers a potential means of reducing the costs of treating patients with primary care problems

Footnotes

  • Funding JD was funded by the Lambeth Inner City Partnership, and JG by the King's Fund. We thank the Medical Research Council and the SETRHA Primary Care Development for additional funding.

  • Conflict of interest None.

  • Accepted 12 April 1996

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