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A survey of general practitioner’s opinion on the proposal to introduce ‘treat and referral’ into the Irish emergency medical service

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Abstract

Background

The introduction of treat and referral by ambulance practitioners is under active consideration in Ireland. The Irish ambulance services have traditionally transported all patients following an emergency (112/999) call to an emergency department. The introduction of treat and referral will present a significant care pathway change.

Aims

To engage GPs in relation to the proposed introduction of treat and referral.

Methods

A postal survey of 50 general practices in the southeast of Ireland was completed in 2019 to identify their opinion on the introduction of treat and referral. Descriptive statistics were calculated, and Pearson’s chi-square tests were used to identify statistically significant differences among GP cohorts.

Results

A 78% response rate was achieved. Respondents indicated that informal treat and referral was practised by 40% of GPs. A significant majority of GPs indicated that their patients with diabetes or epilepsy would benefit from treat and referral and were happy for paramedics to make appointments posthypoglycaemia or seizure. There was no clear consensus in relation to confining treat and referral to adults only. Barriers to the implementation of treat and referral were a significant issue for GPs.

Conclusions

GPs are in the main supportive of the introduction of treat and referral; however, they have identified several barriers that may inhibit successful introduction. Importantly, a GP appointment within 48 h does not appear to be a barrier. The adequacy of the working relationships between GPs and the ambulance service and its practitioners appears to have reduced since 2006, which is concerning.

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References

  1. van den Berg MJ, van Loenen T, Westert GP (2016) Accessible and continuous primary care may help reduce rates of emergency department use. An international survey in 34 countries. Fam Pract 33(1):42–50. https://doi.org/10.1093/fampra/cmv082

    Article  PubMed  Google Scholar 

  2. Beillon LM, Suserud BO, Karlberg I, Herlitz J (2009) Does ambulance use differ between geographic areas? A survey of ambulance use in sparsely and densely populated areas. Am J Emerg Med 27(2):202–211. https://doi.org/10.1016/j.ajem.2008.01.012

    Article  PubMed  Google Scholar 

  3. Alpert A, Morganti KG, Margolis GS, Wasserman J, Kellermann AL (2013) Giving EMS flexibility in transporting low-acuity patients could generate substantial Medicare savings. Health Aff (Millwood) 32(12):2142–2148. https://doi.org/10.1377/hlthaff.2013.0741

    Article  Google Scholar 

  4. Booker MJ, Shaw AR, Purdy S (2015) Why do patients with ‘primary care sensitive’ problems access ambulance services? A systematic mapping review of the literature. BMJ Open 5(5):e007726. https://doi.org/10.1136/bmjopen-2015-007726

    Article  PubMed  PubMed Central  Google Scholar 

  5. Snooks H, Foster T, Nicholl J (2004) Results of an evaluation of the effectiveness of triage and direct transportation to minor injuries units by ambulance crews. Emerg Med J 21(1):105–111

    Article  CAS  Google Scholar 

  6. Raatiniemi L, Brattebo G (2018) The challenge of ambulance missions to patients not in need of emergency medical care. Acta Anaesthesiol Scand 62(5):584–587. https://doi.org/10.1111/aas.13103

    Article  CAS  PubMed  Google Scholar 

  7. O’Meara P (2006) The rural and regional ambulance paramedic: moving beyond emergency response. School of Public Health, Charles Sturt University, Bathurst

    Google Scholar 

  8. Khunti K, Fisher H, Paul S, Iqbal M, Davies MJ, Siriwardena AN (2013) Severe hypoglycaemia requiring emergency medical assistance by ambulance services in the East Midlands: a retrospective study. Prim Care Diabetes 7(2):159–165. https://doi.org/10.1016/j.pcd.2013.01.001

    Article  PubMed  Google Scholar 

  9. Osborne A, Taylor L, Reuber M, Grunewald RA, Parkinson M, Dickson JM (2015) Pre-hospital care after a seizure: evidence base and United Kingdom management guidelines. Seizure 24:82–87. https://doi.org/10.1016/j.seizure.2014.09.002

    Article  PubMed  Google Scholar 

  10. Dickson JM, Taylor LH, Shewan J, Baldwin T, Grunewald RA, Reuber M (2016) Cross-sectional study of the prehospital management of adult patients with a suspected seizure (EPIC1). BMJ Open 6(2):e010573. https://doi.org/10.1136/bmjopen-2015-010573

    Article  PubMed  PubMed Central  Google Scholar 

  11. Villani M, Nanayakkara N, Ranasinha S, Tan CY, Smith K, Morgans A, Soldatos G, Teede H, Zoungas S (2016) Utilisation of emergency medical services for severe hypoglycaemia: an unrecognised health care burden. J Diabetes Complicat. https://doi.org/10.1016/j.jdiacomp.2016.04.015

  12. Villarreal M, Leach J, Ngianga-Bakwin K, Dale J (2017) Can a partnership between general practitioners and ambulance services reduce conveyance to emergency care? Emerg Med J 34(7):459–465. https://doi.org/10.1136/emermed-2015-204924

    Article  PubMed  Google Scholar 

  13. Coates D, Rawstorne S, Benger J (2012) Can emergency care practitioners differentiate between an avoided emergency department attendance and an avoided admission? Emerg Med J 29(10):838–841. https://doi.org/10.1136/emermed-2011-200484

    Article  PubMed  Google Scholar 

  14. Cummins NM, Dixon M, Garavan C, Landymore E, Mulligan N, O’Donnell C (2013) Can advanced paramedics in the field diagnose patients and predict hospital admission? Emerg Med J 30(12):1043–1047. https://doi.org/10.1136/emermed-2012-201899

    Article  PubMed  Google Scholar 

  15. Neeki MM, Dong F, Avera L, Than T, Borger R, Powell J, Vaezazizi R, Pitts R (2016) Alternative destination transport? The role of paramedics in optimal use of the emergency department. West J Emerg Med 17(6):690–697. https://doi.org/10.5811/westjem.2016.9.31384

    Article  PubMed  PubMed Central  Google Scholar 

  16. Snooks HA, Dale J, Hartley-Sharpe C, Halter M (2004) On-scene alternatives for emergency ambulance crews attending patients who do not need to travel to the accident and emergency department: a review of the literature. Emerg Med J 21(2):212–215

    Article  CAS  Google Scholar 

  17. Knowles E, Bishop-Edwards L, O’Cathain A (2018) Exploring variation in how ambulance services address non-conveyance: a qualitative interview study. BMJ Open 8(11):e024228. https://doi.org/10.1136/bmjopen-2018-024228

    Article  PubMed  PubMed Central  Google Scholar 

  18. Snooks HA, Kingston MR, Anthony RE, Russell IT (2013) New models of emergency prehospital care that avoid unnecessary conveyance to emergency department: translation of research evidence into practice? TheScientificWorldJournal 2013:182102. https://doi.org/10.1155/2013/182102

    Article  PubMed  PubMed Central  Google Scholar 

  19. Leikkola P, Mikkola R, Salminen-Tuomaala M, Paavilainen E (2016) Non-conveyance of patients: challenges to decision-making in emergency care. BMC Nurs 4:9. https://doi.org/10.5430/cns.v4n4p31

    Article  Google Scholar 

  20. Billings J, Parikh, Nina, Mijanovich, Tod (2000) Emergency department use: the New York story. Issue Brief

  21. Schaefer RA, Rea TD, Plorde M, Peiguss K, Goldberg P, Murray JA (2002) An emergency medical services program of alternate destination of patient care. Prehosp Emerg Care 6(3):309–314

    Article  Google Scholar 

  22. Gratton MC, Ellison SR, Hunt J, Ma OJ (2003) Prospective determination of medical necessity for ambulance transport by paramedics. Prehosp Emerg Care 7(4):466–469

    Article  Google Scholar 

  23. Patton GG, Thakore S (2013) Reducing inappropriate emergency department attendances--a review of ambulance service attendances at a regional teaching hospital in Scotland. Emerg Med J 30(6):459–461. https://doi.org/10.1136/emermed-2012-201116

    Article  PubMed  Google Scholar 

  24. van Loenen T, van den Berg MJ, Westert GP, Faber MJ (2014) Organizational aspects of primary care related to avoidable hospitalization: a systematic review. Fam Pract 31(5):502–516. https://doi.org/10.1093/fampra/cmu053

    Article  PubMed  Google Scholar 

  25. Ebben RHA, Vloet LCM, Speijers RF, Tonjes NW, Loef J, Pelgrim T, Hoogeveen M, Berben SAA (2017) A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review. Scand J Trauma Resusc Emerg Med 25(1):71. https://doi.org/10.1186/s13049-017-0409-6

    Article  PubMed  PubMed Central  Google Scholar 

  26. Tohira H, Fatovich D, Williams TA, Bremner AP, Arendts G, Rogers IR, Celenza A, Mountain D, Cameron P, Sprivulis P, Ahern T, Finn J (2016) Is it appropriate for patients to be discharged at the scene by paramedics? Prehosp Emerg Care 20(4):539–549. https://doi.org/10.3109/10903127.2015.1128028

    Article  PubMed  Google Scholar 

  27. Barry S, Dalton R, Eustace-Cook J (2018) Understanding change in complex health systems (trans: Management CfHPa). Trinity College, Dublin

    Google Scholar 

  28. Dalrymple J, Appleby J (2000) Cross sectional study of reporting of epileptic seizures to general practitioners. BMJ 320(7227):94–97. https://doi.org/10.1136/bmj.320.7227.94

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Ostenson CG, Geelhoed-Duijvestijn P, Lahtela J, Weitgasser R, Markert Jensen M, Pedersen-Bjergaard U (2014) Self-reported non-severe hypoglycaemic events in Europe. Diabet Med 31(1):92–101. https://doi.org/10.1111/dme.12261

    Article  CAS  PubMed  Google Scholar 

  30. Linehan C, Kerr MP, Walsh PN, Brady G, Kelleher C, Delanty N, Dawson F, Glynn M (2010) Examining the prevalence of epilepsy and delivery of epilepsy care in Ireland. Epilepsia 51(5):845–852. https://doi.org/10.1111/j.1528-1167.2009.02417.x

    Article  PubMed  Google Scholar 

  31. Gettings JV, O’Connor R, O’Doherty J, Hannigan A, Cullen W, Hickey L, O’Regan A (2018) A snapshot of type two diabetes mellitus management in general practice prior to the introduction of diabetes cycle of care. Ir J Med Sci 187(4):953–957. https://doi.org/10.1007/s11845-018-1754-9

    Article  CAS  PubMed  Google Scholar 

  32. Lerner EB, Billittier AJ, Lance DR, Janicke DM, Teuscher JA (2003) Can paramedics safely treat and discharge hypoglycemic patients in the field? Am J Emerg Med 21(2):115–120. https://doi.org/10.1053/ajem.2003.50014

    Article  PubMed  Google Scholar 

  33. Kaufmann MA, Nelson DR, Kaushik P, Mann NC, Mitchell B (2019) Hypoglycemia emergencies: factors associated with prehospital care, transportation status, emergency department disposition, and cost. Prehosp Emerg Care 23(4):453–464. https://doi.org/10.1080/10903127.2018.1528322

    Article  PubMed  Google Scholar 

  34. Sahlqvist S, Song Y, Bull F, Adams E, Preston J, Ogilvie D, iConnect c (2011) Effect of questionnaire length, personalisation and reminder type on response rate to a complex postal survey: randomised controlled trial. BMC Med Res Methodol 11:62. https://doi.org/10.1186/1471-2288-11-62

    Article  PubMed  PubMed Central  Google Scholar 

  35. Jeong HJLW (2016) The level of collapse we are allowed: comparison of different response scales in safety attitudes questionnaires. Biometrics & Biostatistics International Journal 4(4):00100. https://doi.org/10.15406/bbij.2016.04.00100

    Article  Google Scholar 

  36. Brophy S, Lynch, D (2018) Government expenditure on general practice (trans: Reform DoPEa). Spending Review 2018. LABOUR MARKET & ENTERPRISE POLICY DIVISION, Dublin

  37. Maher B, O’Neill R, Faruqui A, Bergin C, Horgan M, Bennett D, O’Tuathaigh CMP (2018) Survey of Irish general practitioners’ preferences for continuing professional development. Educ Prim Care 29(1):13–21. https://doi.org/10.1080/14739879.2017.1338536

    Article  CAS  PubMed  Google Scholar 

  38. Mark O’Kelly CT, O’Kelly F, Shúilleabháin AN, O’Dowd T (2016) Structure of general practice in Ireland 1982–2015 (trans: Sciences TCCfH). Trinity College Dublin, Dublin

    Google Scholar 

  39. Bury G, Egan M, Reddy L (2006) EMTs and GPs: what do we think of each other? Emerg Med J 23(7):534–536. https://doi.org/10.1136/emj.2005.032185

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. O’Dowd T, Ivers J, Handy D (2018) A future together building a better GP and primary care service. Trinity College Dublin, Dublin

    Google Scholar 

  41. Health Service Executive (2018) Model of integrated care for patients with type 2 diabetes a guide for health care professionals (clinical management guidelines). Dublin

  42. Chan B, Proudfoot J, Zwar N, Davies GP, Harris MF (2011) Satisfaction with referral relationships between general practice and allied health professionals in Australian primary health care. Australian Journal Of Primary Health 17(3):250–258. https://doi.org/10.1071/PY10026

    Article  PubMed  Google Scholar 

  43. Marjanovic S, Garrod B, Dubow T, Pitchforth E, Lichten CA, Elston J, Harte E, Sussex J, Yang M, Malik F, Lewis R, Ling T (2018) Transforming urgent and emergency care and the vanguard initiative: learning from evaluation of the southern cluster. Rand Health Q 7(4):2

    PubMed  PubMed Central  Google Scholar 

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Availability of data and material

Original data is available for review.

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Authors and Affiliations

  1. Pre-Hospital Emergency Care Council, Beech House, Millennium Pk, Naas, Co. Kildare, W91 TK7N, Ireland

    Brian Power

  2. Centre for Emergency Medical Science, University College Dublin, Dublin, Ireland

    Gerard Bury

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  1. Brian Power
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Contributions

The corresponding author developed the questionnaire, analysed the data, and drafted the manuscript. The co-author supervised the research and edited the manuscript.

Corresponding author

Correspondence to Brian Power.

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The authors declare that they have no conflict of interest.

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Ethical approval was received from the Office of Research Ethics, University College Dublin.

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Respondents to the survey consented by their voluntary participation in the survey.

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Power, B., Bury, G. A survey of general practitioner’s opinion on the proposal to introduce ‘treat and referral’ into the Irish emergency medical service. Ir J Med Sci 189, 1457–1463 (2020). https://doi.org/10.1007/s11845-020-02224-4

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  • DOI: https://doi.org/10.1007/s11845-020-02224-4

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