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. 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. 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. 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.

中文翻译：

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对提供初级保健服务的急诊部门是否产生“提供者诱导的需求”的现实主义分析

目前尚不清楚提供初级保健服务的急诊科 (ED) 是否会影响对非紧急护理的需求（“提供者引发的需求”）。我们提出，急诊科中不同的初级保健服务会鼓励初级保健需求，而整合到急诊科的初级保健可能不太可能引起额外的需求。我们旨在探索并解释影响需求的背景 (C)、机制 (M) 和结果 (O)。我们使用现实主义评估方法并观察 ED 服务交付。24 名患者和 106 名工作人员（包括临床主任和全科医生）在英格兰和威尔士的 13 个 ED 接受了采访（30 天 240 小时的观察）。通过创建“CMO”配置来分析来自观察和访谈的现场记录，以开发和完善与需求驱动因素相关的理论。拥有不同初级保健服务的 ED 被认为会吸引对初级保健的需求，因为服务是可见的、已知的或能够直接获得医疗保健服务。其他影响因素包括患者获得初级保健的经历、社区护理能力、服务设计和人群特征。患者、当地系统和更广泛的系统因素可能会导致 ED 的额外需求，包括初级保健服务。我们的研究结果可以为服务提供商和政策制定者制定策略以在需求超过容量时限制潜在影响对额外需求的影响提供信息。其他影响因素包括患者获得初级保健的经历、社区护理能力、服务设计和人群特征。患者、当地系统和更广泛的系统因素可能会导致 ED 的额外需求，包括初级保健服务。我们的研究结果可以为服务提供商和政策制定者制定策略以在需求超过容量时限制潜在影响对额外需求的影响提供信息。其他影响因素包括患者获得初级保健的经历、社区护理能力、服务设计和人群特征。患者、当地系统和更广泛的系统因素可能会导致 ED 的额外需求，包括初级保健服务。我们的研究结果可以为服务提供商和政策制定者制定策略以在需求超过容量时限制潜在影响对额外需求的影响提供信息。