Effect of general practitioner’s presence at accident site: a systematic review
National expertise service for traumatology asked the Norwegian Institute of Public Health to examine the effect the presence of a general practitioner on accident site.
- Issued/Revised: 06.2017
- By: Folkehelseinstituttet
In Norway the general practitioner in charge of emergency care in the municipality must ensure that the population receive proper medical treatment in acute critical situations. National expertise service for traumatology asked the Knowledge Center at Norwegian Institute of Public Health to examine the effect the presence of a general practitioner on accident site has on
- time spent at the site
- choice of transport destination
- assessment of urgency
- number of admissions
- number of cancelations of ambulance with specialist personnel
We have searched systematically in relevant medical and healthcare databases for controlled studies. We did not identify any studies that answered our question. The effect of having a general practitioner at the accident site is uncertain.
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In Norway, primary healthcare is responsible for providing emergency healthcare to the population. It varies how this work is organized and carried out in practice. The physician in charge of the emergency care is a general practitioner in primary healthcare and must make sure that everyone receives proper medical follow-up and treatment, and decide whether it is the hospital or the primary healthcare who should take care of the patient. The physician in charge of the emergency care may entrust situations to ambulance services or specialist personnel when it is appropriate, but it is expected that they are called when serious injuries occur.
The presence of the general practitioner at the accident site could affect different parts of the patient treatment because the general practitioner may have better prerequisites for assessing who should treat the patient and where. It could possibly spare resources by cancelling ambulances from specialist care.
The purpose of this systematic review is to examine how survival, time spent at the accident site, the choice of transport destination, assessment of urgency, the number of admissions and the number of cancellations of ambulance with specialist personnel are affected by the presence of a general practitioner at the accident site. It is appropriate to investigate the effect of the presence of the general practitioner irrespective of which others are called out.
We have searched for published and planned systematic reviews and primary studies in relevant medical and healthcare databases, trial registries and sources for grey literature. The search was completed in June 2016.
Two persons have independently screened references and assessed whether they meet the inclusion criteria. Two persons have read the potentially relevant in full text. Relevant situations were externally applied severe injury, and relevant intervention was emergency physician's presence at the accident site. Physicians in charge of the emergency care in Norway are general practitioners under contract with the municipality's health administration. In other countries, there may be a general practitioner who is sent out to the accident site in his or her district. The studies must have intended to investigate the effect by experimental trials with or without randomization, controlled before-after studies or interrupted time series studies and repeated measures studies with at least three data points before and three after introduction of the intervention.
We planned that two persons independently should assess the risk of bias in included studies. The project manager was going to extract information from the studies and consider the quality of the documentation, while one other person would double check this.
Two external peer reviewers have read and commented on the project plan and the full report to assure the quality of the work.
We went through 1,302 references to systematic reviews and 4113 references to primary studies. We read and considered 45 primary studies in full text. None of these fulfilled the inclusion criteria.
We excluded most studies either because they had not considered the effect of sending a general practitioner to the accident site or because the study had not determined study groups and intervention before the study was initiated. By using natural study groups the way that it is done in most of these studies, there is a risk of getting an unfair comparison. If the general practitioner is sent only to the most serious injuries, it may look like it affects the patients negatively when a general practitioner is called out to the accident.
We found no studies that met our inclusion criteria. We do not know the effect of the presence of a general practitioner on accident site.