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112 Urgences KCE reports vol. 19B
Publication
Data
Murphy
AW et al.
Effect of the
introduction
of a financial
incentive for
fee-paying
A&Eattenders
to
consult their
general
practitioner
before
attending the
A&E
department.
Family
Practice
1997; 14 (5)
included in the
analysis of 305
pat. who were
previously
admitted to ED
with the same
copa.
the inhospital case fatality
rate.
MESH-terms Objective Planning Conclusion Material/Methods Results / Comments Comments/Discussion
Financial
incentive
GP consult
before A&E
dept. consult
To compare
the number of
GMS-ineligible
patients
referred by a
GP during the
year before and
the year after
the
implementation
of the
regulations.
Explanatory
notes:
GMS-ineligible
patients who
are liable for
their own
health costs
GMS-eligible
patients who
benefit from
free care
GMS global
medical
services
Retrospective
audit (before
and after
01.03.94)
Epidemiological
Non
randomized
Stratified by
eligibility of
patients,
complaint
severity, time of
attendance
Starting
hypothesis:
the patients
who would be
most responsive
to the new
incentive would
be those GMSineligible
patients
attending with a
minor complaint
between 08.00
The
introduction of
the regulations
was associated
with a small but
statistically
significant
reduction in the
number of GMSineligible
patients with
non-emergency
conditions.
The proportion
of GMSineligible
attenders who
were referred
by a GP
increased by
44% (95% CI).
Workload of ED
unaffected.
Data extracted from St.
JansÊ Hospital in Dublin
(490 acute beds,
catchments population of >
200.000)
For a calendar year before
and after the introduction
of new regulations
Classification by :
- eligibility status
- severity of symptoms
(triage + 5 categories)
- referral source (GP, letter
or phone)
No control hospital
80.000 patients
44% increase of total GPreferred
GMS-ineligible
patients
Proportion of daytime GMSineligible
patients in triage
categories semi-urgent, nonurgent,
referred by a GP
rose by 3%
- Hypothesis is true.
- Weaknesses of the study:
- determination of GMSeligibility
entirely
dependent on the patient
without any verification
- extrapolation of the
results of both studies
outside the USA is
problematical (limited
access to primary care)
- further evaluation of this
incentive on the health
status of patients has to
be done (with EBMparameters)