General Practitioners and Emergency Departments (GPED)
| ISRCTN | ISRCTN51780222 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN51780222 |
| Secondary identifying numbers | 35646 |
- Submission date
- 06/11/2017
- Registration date
- 04/01/2018
- Last edited
- 14/02/2024
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Other
Plain English Summary
Background and study aims
Pressure continues to grow on Emergency Departments (EDs) in the United Kingdom, with declining performance and adverse effects on patient outcome, safety and experience. One proposed solution is to locate general practitioner (GPs) in or alongside the ED, with a number of models introduced. Currently 40% of Beds report primary care co-location, however evidence of effectiveness is weak. There is no consensus regarding the most efficient model of care, or ever whether GPs should be employed in this way. The aims of this study are to examine the impact of GP’s working in or alongside the ED (GPED) on patient care, the primary care and acute hospital team and the wider urgent care system and the differential impact of alternative service models of GPED.
Who can participate?
Adult ED patients, their cares and staff working in ED.
What does the study involve?
This study contains three parts. The first two parts of the study builds on previous work on the current models of GPED and the impact of those models using Hospital Episode Statistics (HES) data. The third part of the study analyses study sites who are about to implement and who have already implemented a GPED model of care. Patient/Carer participants who take part in the study take part in a short interview (up to 30 minutes) with a researcher about their views and experiences of ED, with permission they may also have their care in ED observed. This takes place for a period of 1-2 weeks. Those sites who have not yet implemented the GPED model of care, these interviews and observations are done before the model of care is implemented and 12 months after. Surveys are also administered to ED staff to assess their perspectives on the models of care. For established sites this is administered once, for prospective sites this are administered before GPED implementation, and 12 months later.
What are the possible benefits and risks of participating?
There are no direct benefits to participation. Interviewing patients about their views and experiences of the Emergency Department will help to understand the effect of GPs working in the Emergency Department on patient care. It will give a more detailed understanding of the challenges and benefits of such care, and ways that it could be improved. There are no risks with participation.
Where is the study run from?
This study is being run by University of the West of England (UK) and takes place in hospitals in the UK.
When is the study starting and how long is it expected to run for?
October 2017 to May 2020
Who is funding the study?
National Institute for Health Research (UK)
Who is the main contact?
Prof Jonathan Benger, Jonathan.Benger@uwe.ac.uk
Contact information
Scientific
University of the West of England
Glenside Campus
Blackberry Hill
Bristol
BS16 1DD
United Kingdom
 ORCID ID |
0000-0001-6131-0916 |
|---|---|
| Phone | +44 117 328 2942 |
| Jonathan.Benger@uwe.ac.uk |
Study information
| Study design | Observational; Design type: Qualitative |
|---|---|
| Primary study design | Observational |
| Secondary study design | Case-control study |
| Study setting(s) | Hospital |
| Study type | Treatment |
| Participant information sheet | Not available in web format, please use the contact details below to request a patient information sheet |
| Scientific title | General Practitioners and Emergency Departments (GPED): Efficient Models of Care |
| Study hypothesis | The study will address the following research questions : 1. What is the impact of GP’s working in or alongside the ED (GPED) on patient care, the primary care and acute hospital team and the wider urgent care system? 2. What is the differential impact of alternative service models of GPED? |
| Ethics approval(s) | East Midlands- Leicester South Research Ethics Committee, 23/08/2017, ref: 17/EM/0312 |
| Condition | Health services and delivery research |
| Intervention | This is a mixed-methods study, comprising three work packages: Work Package A: Mapping, Taxonomy and Interviews This work package maps, describes and classifies current models of GPED in all EDs in England, building on previous work. Through interviews with key informant, this part of the study examines the hypotheses that underpin GPED and its anticipated benefits. Work Package B: Quantitative Analysis of National Data This work package measures the impact of the models of GPED identified in WP-A, compared to a no-GPED model, using routinely available Hospital Episode Statistics (HES) data. It also calculates costs and consequences of the different GPED models. Work Package C: Case Studies Completes a detailed mixed-methods analysis in ten case study sites that are about to implement (six sites), or have already implemented (four sites) a GPED model of care. Work Package C consists of semi-structured interviews and non-participant observation of consenting staff, patients and carers in ED. They are interviewed for up to 30 minutes, and also have their care/clinical practice observed for up to two hours. For established sites this data collection takes place once over a period of 1-2 weeks. For prospective sites this takes place for 1-2 weeks prior to GPED implementation, and repeated 12 months later. A workforce survey is also be administered to the ED staff to access perspectives on current and proposed models of care. For established sites this is administered once, for prospective sites this are administered longitudinally; before GPED implementation, and 12 months later. |
| Intervention type | Other |
| Primary outcome measure | The number of ED attendances measured before and after GPED implementation. |
| Secondary outcome measures | The following are assessed using routinely collected HES data: 1. 4 hour performance 2. Unplanned ED re-attendance within 7 days 3. Mortality within 28 days after attendance 4. Emergency hospital admission 5. Zero day admission (subject to an examination of coding behaviour by hospital Trusts) |
| Overall study start date | 11/10/2017 |
| Overall study end date | 31/05/2020 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | Adult |
| Sex | Both |
| Target number of participants | Planned Sample Size: 1048; UK Sample Size: 1048 |
| Total final enrolment | 1081 |
| Participant inclusion criteria | 1. Adult patients presenting at ED 2. Carers of patients presenting at ED 3. Staff working in ED |
| Participant exclusion criteria | Work Package C (Qualitative) 1. Patients aged under 18 years 2. Critically ill patients. (We will be led by NHS staff who will identify patients not appropriate for inclusion in study) 3. Non-English speakers 4. Patients who lack capacity (e.g. due to cognitive impairment) |
| Recruitment start date | 11/10/2017 |
| Recruitment end date | 31/12/2019 |
Locations
Countries of recruitment
- England
- United Kingdom
Study participating centres
Luton
LU4 0DZ
United Kingdom
Harrogate
HG2 7SX
United Kingdom
Chertsey
Lyne
KT16 0PZ
United Kingdom
Headington
Oxford
OX3 9DU
United Kingdom
Newcastle upon Tyne
NE1 4LP
United Kingdom
Sponsor information
Hospital/treatment centre
Coldharbour Lane
Bristol
BS16 1QY
England
United Kingdom
"ROR" |
https://ror.org/02nwg5t34 |
|---|
Funders
Funder type
Government
Government organisation / National government
- Alternative name(s)
- National Institute for Health Research, NIHR Research, NIHRresearch, NIHR - National Institute for Health Research, NIHR (The National Institute for Health and Care Research), NIHR
- Location
- United Kingdom
Results and Publications
| Intention to publish date | 31/05/2021 |
|---|---|
| Individual participant data (IPD) Intention to share | No |
| IPD sharing plan summary | Not expected to be made available |
| Publication and dissemination plan | Academic outputs will include a minimum of three papers, submitted to high-impact peer reviewed journals, and at least four conference presentations or workshops. |
| IPD sharing plan | The deidentified patient-level data used for the quantitative component of this study, including information on mortality, were released by the data holders (NHS Digital, Office for National Statistics) under specific data sharing agreements and only for the purpose of this study. The data sharing agreements do not permit further sharing or publication of the data. Interested parties may seek to obtain data directly from the relevant data holders. Hospital Episode Statistics (HES) data are copyright 2018-2019, reused with the permission of NHS Digital through Data Sharing Agreement NIC-84254-J2G1Q. The data about the hours a general practitioner services was operating in emergency departments was collected by the authors specifically for this project. The authors are not able to place the original data into the public domain. The qualitative data we have acquired will not be available as our ethical approval does not permit the sharing of the entire data set. |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Protocol article | protocol | 03/10/2018 | Yes | No | |
| Other publications | initial qualitative findings | 24/05/2021 | 26/05/2021 | Yes | No |
| Other publications | qualitative analysis | 01/08/2021 | 10/06/2021 | Yes | No |
| HRA research summary | 28/06/2023 | No | No | ||
| Other publications | Qualitative results | 20/04/2022 | 14/02/2024 | Yes | No |
| Results article | 01/10/2022 | 14/02/2024 | Yes | No |
Editorial Notes
14/02/2024: Publication references added.
11/07/2022: The following changes were made to the trial record:
1. The scientific contact was changed.
2. The total final enrolment was added.
3. The participant level data sharing pan was added.
4. The plain English summary was updated to reflect these changes.
10/06/2021: Publication reference added.
26/05/2021: Publication reference added.
20/06/2019: The following changes were made to the trial record:
1. The recruitment end date was changed from 30/05/2019 to 31/12/2019.
2. The overall end date was changed from 30/05/2020 to 31/05/2020.
3. The intention to publish date was changed from 01/03/2020 to 31/05/2021.
25/04/2019: Dr Katherine Morton has been replaced as the scientific contact by Dr Heather Brant.
29/03/2019: The condition has been changed from "Specialty: Health services and delivery research, Primary sub-specialty: Health Services and Delivery Research; UKCRC code/ Disease: Generic Health Relevance/ No specific disease" to "Health services and delivery research" following a request from the NIHR.
09/10/2018: Publication reference added.
06/12/2017: The ISRCTN prospective/retrospective flag compares the date of registration with the recruitment start date and does not include any grace period. The registration of this study was requested through the NIHR Portfolio and was finalised within 6 months of the recruitment starting.
