Bickerton Jane, Davies Jacqueline, Davies Helen, Apau Daniel, Procter Susan
London School of Health Sciences, City University, London, UK.
Prim Health Care Res Dev. 2012 Apr;13(2):142-52. doi: 10.1017/S146342361100017X. Epub 2011 Jul 21.
To identify the appropriate service provider attendees of emergency departments (EDs) and walk-in centres (WiCs) in North East London and to match this to local service provision and patient choice.
An anonymous patient survey and a retrospective analysis of a random sample of patient records were performed. A nurse consultant, general practitioner (GP) and pharmacist used the presenting complaints in the patients' records to independently stream the patient to primary care services, non-National Health Services or ED. Statistical analysis of level of agreement was undertaken. A stakeholder focus group reviewed the results.
Adult health consumers attending ED and urgent care services in North East London.
The health user survey identified younger rather than older users (mean age of 35.6 years--SD 15.5), where 50% had not seen a health professional about their concern, with over 40% unable to obtain a convenient or emergency appointment with their GP. Over a third of the attendees were already receiving treatment and over 40% of these saw their complaint as an emergency. Over half of respondents expected to see a doctor, one-quarter expected to see a nurse and only 1% expected to see a pharmacist across both services, although WiCs are nurse-led services. More respondents expected a prescription from a visit to a WiC, whereas in the ED a third of respondents sought health advice or reassurance.
A number of unscheduled care strategies are, or have just been, developed with the emphasis on moving demand into community-based services. Plurality of services provides service users with a range of alternative access points but can cause duplication of services and repeat attendance. Managing continued increase in emergency and unscheduled care is a challenge. The uncertainties in prospective decision making could be used to inform service development and delivery.
确定伦敦东北部急诊科（EDs）和随诊中心（WiCs）的合适服务提供者，并将其与当地服务提供情况和患者选择相匹配。
进行了一项匿名患者调查，并对患者记录的随机样本进行回顾性分析。一名护士顾问、全科医生（GP）和药剂师利用患者记录中的主诉，独立地将患者分流到初级保健服务、非国民健康服务或急诊科。对一致性水平进行了统计分析。一个利益相关者焦点小组对结果进行了审查。
伦敦东北部使用急诊科和紧急护理服务的成年健康消费者。
健康用户调查发现，使用这些服务的用户以年轻人为主，而非老年人（平均年龄35.6岁，标准差15.5），其中50%的人未就其担忧的问题咨询过医疗专业人员，超过40%的人无法获得与全科医生方便的预约或紧急预约。超过三分之一的就诊者已经在接受治疗，其中超过40%的人认为自己的病情紧急。超过一半的受访者期望看医生，四分之一期望看护士，尽管随诊中心是由护士主导的服务，但在这两种服务中，只有1%的受访者期望看药剂师。更多的受访者期望从随诊中心的就诊中获得处方，而在急诊科，三分之一的受访者寻求健康建议或安心。
已经制定了一些非预约护理策略，或刚刚制定，重点是将需求转移到社区服务。服务的多元化为服务使用者提供了一系列替代接入点，但可能导致服务重复和再次就诊。应对急诊和非预约护理持续增加的情况是一项挑战。前瞻性决策中的不确定性可用于为服务开发和提供提供信息。
