Division of Population Medicine, School of Medicine, Cardiff University, UK.
Faculty of Health and Applied Sciences, The University of the West of England, Bristol, UK.
Emerg Med J. 2019 Oct;36(10):625-630. doi: 10.1136/emermed-2018-208305. Epub 2019 Sep 7.
Primary care services in or alongside emergency departments look and function differently and are described using inconsistent terminology. Research to determine effectiveness of these models is hampered by outdated classification systems, limiting the opportunity for data synthesis to draw conclusions and inform decision-making and policy. We used findings from a literature review, a national survey of Type 1 emergency departments in England and Wales, staff interviews, other routine data sources and discussions from two stakeholder events to inform the taxonomy. We categorised the forms inside or outside the emergency department: inside primary care services may be integrated with emergency department patient flow or may run parallel to that activity; outside services may be offered on site or off site. We then describe a conceptual spectrum of integration: identifying constructs that influence how the services function-from being closer to an emergency medicine service or to usual primary care. This taxonomy provides a basis for future evaluation of service models that will comprise the evidence base to inform policy-making in this domain. Commissioners and service providers can consider these constructs in characterising and designing services depending on local circumstances and context.
急诊部内外的基层医疗服务在外观和功能上有所不同，并且使用的术语也不一致。由于过时的分类系统，这些模型的有效性研究受到阻碍，限制了数据综合的机会，无法得出结论并为决策和政策提供信息。我们使用文献综述、对英格兰和威尔士 1 型急诊部的全国调查、员工访谈、其他常规数据来源以及两次利益相关者活动的讨论结果来为分类法提供信息。我们对急诊部内外的形式进行了分类：内部基层医疗服务可能与急诊部患者流程相结合，也可能与该活动平行运行；外部服务可能在现场或现场外提供。然后，我们描述了一个整合的概念范围：确定影响服务功能的结构——从更接近急诊医学服务到通常的基层医疗服务。该分类法为未来的服务模式评估提供了基础，这些评估将构成该领域决策的证据基础。管理者和服务提供者可以根据当地情况和背景，考虑这些结构来描述和设计服务。
