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Realist analysis of whether emergency departments with primary care services generate 'provider-induced demand'

McFadzean, I.J., Edwards, M. ORCID:, Davies, F. ORCID:, Cooper, A. ORCID:, Price, D., Carson-Stevens, A. ORCID:, Dale, J., Hughes, T., Porter, A., Harrington, B., Siriwardena, N., Anderson, P. and Edwards, A. ORCID: 2022. Realist analysis of whether emergency departments with primary care services generate 'provider-induced demand'. BMC Emergency Medicine 22 (1) , 155. 10.1186/s12873-022-00709-2

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Abstract: Background: It is not known whether emergency departments (EDs) with primary care services influence demand for non-urgent care (‘provider-induced demand’). We proposed that distinct primary care services in EDs encourages primary care demand, whereas primary care integrated within EDs may be less likely to cause additional demand. We aimed to explore this and explain contexts (C), mechanisms (M) and outcomes (O) influencing demand. Methods: We used realist evaluation methodology and observed ED service delivery. Twenty-four patients and 106 staff members (including Clinical Directors and General Practitioners) were interviewed at 13 EDs in England and Wales (240 hours of observations across 30 days). Field notes from observations and interviews were analysed by creating ‘CMO’ configurations to develop and refine theories relating to drivers of demand. Results: EDs with distinct primary care services were perceived to attract demand for primary care because services were visible, known or enabled direct access to health care services. Other influencing factors included patients’ experiences of accessing primary care, community care capacity, service design and population characteristics. Conclusions: Patient, local-system and wider-system factors can contribute to additional demand at EDs that include primary care services. Our findings can inform service providers and policymakers in developing strategies to limit the effect of potential influences on additional demand when demand exceeds capacity.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Prime Centre Wales (PRIME)
Publisher: BioMed Central
ISSN: 1471-227X
Funders: NIHR HS&DR Project 15/145/04
Date of First Compliant Deposit: 17 August 2022
Date of Acceptance: 16 August 2022
Last Modified: 28 May 2023 17:51

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