title: Towards integration of general practitioner posts and accident and emergency departments: a case study of two integrated emergency posts in the Netherlands.
abstract: BACKGROUND
  Accident and emergency (A&E) departments and general practitioner (GP) posts are often used inappropriately, leading to overcrowding. In the Netherlands, increasingly more integrated emergency posts (IEPs) are being created, integrating the care provided by GP posts and A&E departments, in order to improve the provision of the emergency care.
  
  
  METHODS
  This explorative study compares the efficiency and patient and employee satisfaction in IEPs with those in two GP posts and two A&E departments. To this end, information was retrieved from hospital and GP patient records for the first quarter of the year before and of the year after the creation of IEPs. Patients and employees were sent a questionnaire to measure their satisfaction. Lastly, groups of hospital doctors, GPs, GP assistants, and nurses were interviewed.
  
  
  RESULTS
  After the creation of IEPs, there was a shift of more than fifteen percent from secondary care to primary care for emergency consultations and waiting/consultation times were shortened by more than ten percent. Compared with the control settings, patients were more satisfied about telephone contact with an IEP, but professionals working at the IEP were less satisfied with several aspects of their work.
  
  
  CONCLUSIONS
  IEPs could be a promising innovation to organize emergency care more efficiently; however, it might take time to convince professionals of the possible advantages. Studies involving more IEPs and longer follow-up times are needed to determine whether such integration should be stimulated.
authors.affiliation: Quality and Safety Department, Prismant Institute for Research in Health Care, Utrecht, the Netherlands. tijn.kool@prismant.nl
authors.forename: Rudolf B
authors.initials: RB
authors.lastname: Kool
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Homberg
authors.forename: Helen C M
authors.initials: HC
authors.lastname: Kamphuis
mesh_terms: D039602:After-Hours Care / Q000458:organization & administration; D001071:Appointments and Schedules; D001291:Attitude of Health Personnel; D016022:Case-Control Studies; D003625:Data Collection; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005194:Family Practice / Q000458:organization & administration*; D007407:Interviews as Topic; D007588:Job Satisfaction; D009426:Netherlands; D009726:Nurses; D019982:Organizational Case Studies; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D017060:Patient Satisfaction; D010820:Physicians; D010865:Pilot Projects; D014218:Triage / Q000458:organization & administration*