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The work combines an integrative systematic review with a cohort study to identify barriers and enablers for effective ED-to-primary care transitions. Findings show improved transition outcomes when insurance coverage, payment ease, communication, prior primary care booking, and transport access are available, yet financial hardship and fee-rebate shortfalls undermine follow-up, especially for patients without a regular GP.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/the-influence-of-having-a-general-practitioner-on-emergency-department-presentations-thesis-doctorate-of-nurse-practitioner-research/199498/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/the-influence-of-having-a-general-practitioner-on-emergency-department-presentations-thesis-doctorate-of-nurse-practitioner-research/199498.png","ImageObject",300,407,{"name":92,"@type":93},"Emma Mercer","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-05","2026-09-04",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What problem does the thesis address regarding emergency department use?","Question",{"text":112,"@type":113},"The thesis addresses increasing ED presentations and overcrowding, focusing on how suboptimal transitions from ED to primary care can lead to repeat representations.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were the literature and cohort evidence gathered?",{"text":117,"@type":113},"An integrative systematic review followed PRISMA guidance with searches across multiple databases and included a quality assessment with narrative synthesis. A cohort study used variables from patients presenting over three months in 2022 and applied descriptive and inferential statistics including truncated Poisson regression models.",{"name":119,"@type":110,"acceptedAnswer":120},"What factors were associated with a more successful ED-to-primary care transition?",{"text":121,"@type":113},"Successful transitions were associated with insurance access, ease of payment, effective communication, prior booking of primary care appointments, and access to transportation.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},199498,1788506154,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":129,"read_time":144,"preview_page_count":4},962084925502,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","The Influence of Having a General Practitioner on Emergency Department Presentations  \nKathleen Marie Hain  \nMarch 2025  \nThesis submitted in fulfilment for the degree of Doctorate of Nurse Practitioner (Research) at  \nthe  \nUniversity of Canberra, Australian Capital Territory, Australia  \nIt always seems impossible until it’s done.  \nNelson Mandela  \nAbstract  \nIntroduction: Increasing numbers of patients are presenting to the emergency department (ED) for medical treatment, adding to the problem of overcrowding. Suboptimal transitions from the ED to primary care providers (PCP) can result in representations to the ED. It is suspected that having a general practitioner (GP) reduces ED presentations and improves follow up with GPs post ED presentation, thereby reducing representations.  \nAim: The integrative systematic review aimed to identify the barriers and enablers of effective care transition between the ED and PCP. The cohort study established variables that affect the frequency and nature of ED presentations and assessed the influence of having a GP on this frequency in our region.  \nMethods: An integrative systematic review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines (PROSPERO CRD42022316165) . A search strategy was applied to extract articles from CINAHL, MEDLINE, PsycINFO, Scopus, and ProQuest Nursing and Allied Health databases. Articles were assessed using predetermined eligibility criteria. A quality assessment and narrative synthesis was conducted.  \nA cohort study, reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement, included patients presenting over three months in 2022. Descriptive, inferential statistics, and univariate and multivariate truncated Poisson regression models were tested in this doctoral thesis.  \nKey Results: The integrative systematic literature review included 29 studies. The study designs included four qualitative, three mixed-methods, and 22 quantitative studies. A successful care transition was enhanced by access to insurance, ease of payment methods, effective communication, prior booking of PC appointments, and access to transportation. Many patients experienced financial hardship, influencing GP follow-up after ED discharge.  \nThe cohort included 4,990 patients with 5,880 ED presentations. Twelve percent of the patients did not have a GP. Patients without a GP were more likely to be male, aged between 16 and 45 years, born overseas, be of Indigenous or Torres Strait Islander origin, and live in areas other than inner-regional remoteness areas. Patients with a GP were 1.3 times more likely to make  \nrepeat visits to the ED than patients without a GP (IRR 1.3, SE 0.2, p = 0.115) . Patients aged 46-60 with a GP were seven times more likely to have multiple ED visits than patients without GPs (IRR 7.0, SE 4.9, p = 0.005). Patients with GPs were 1.9 times more likely to have multiple ED visits in GP trading hours (IRR 1.9, SE 0.5, p = 0.013) . Patients with a GP triaged as urgent were 2.2 times as likely to have multiple presentations as patients without a GP (IRR 2.2, SE 1.2, p = 0.135) .  \nConclusion: The integrative systematic review found that a successful transition between ED and PC was enhanced by access to insurance, ease of payment methods, effective communication, prior booking of PC appointments, and access to transportation. Many patients experienced financial toxicity, and the shortfall between fees charged and rebates provided was found to influence PC follow-up compliance. Patients without a regular PCP faced additional challenges to safe and effective transitions of care. The cohort study found that patients with a GP were more likely to have multiple visits to the ED than patients without a GP. Many of these visits occurred during GP hours, which suggests potential barriers to timely access or affordability of appointments. To reduce unplanned and","cbCailfZ4U4geH2p","https://ap.wps.com/l/cbCailfZ4U4geH2p","pdf",3138659,183,"English","# Abstract\n## Introduction\n## Aim\n## Methods\n## Key Results\n## Conclusion\n# Acknowledgements","[{\"question\":\"What problem does the thesis address regarding emergency department use?\",\"answer\":\"The thesis addresses increasing ED presentations and overcrowding, focusing on how suboptimal transitions from ED to primary care can lead to repeat representations.\"},{\"question\":\"How were the literature and cohort evidence gathered?\",\"answer\":\"An integrative systematic review followed PRISMA guidance with searches across multiple databases and included a quality assessment with narrative synthesis. A cohort study used variables from patients presenting over three months in 2022 and applied descriptive and inferential statistics including truncated Poisson regression models.\"},{\"question\":\"What factors were associated with a more successful ED-to-primary care transition?\",\"answer\":\"Successful transitions were associated with insurance access, ease of payment, effective communication, prior booking of primary care appointments, and access to transportation.\"}]","The Influence of Having a General Practitioner on Emergency Department Presentations - Thesis Doctorate of Nurse Practitioner (Research) | PDF",461]