Accidents in the community: a role for the primary care team?

Abstract

The aims of this prospective study were to examine the incidence, circumstances and process of care of patients sustaining accidents within a registered practice population of 53,587 with a view to directing preventa tive initiatives. It involved three rural and three urban practices and included all accidents sustained by patients which were reported either directly to primary care or indirectly via Accident & Emergency depart ments over a three-month period. An overall accident rate of 117.6 per thousand registered patients per year was recorded; most of these accidents were minor. Major accidents were most likely to occur at home. Accidents were commonest in patients under 30 (62.4%) and in males (61.5%). Those aged 0-4 or 60+, and females, were at greater risk of domestic accidents. One third of accidents resulted from falls and 10 per cent of accidents resulted in a fracture. Ninety-one per cent of urban patients presented initially to an Accident & Emergency department following an accident, compared with 44 per cent of rural patients. Given that sporting/leisure activity accounts for 40 per cent of all accidents, there is a need for greater supervision and improvements in protective clothing. As most accidents happen in the home and involve the young and the elderly, there would seem to be a role for the primary care team in addressing accident prevention as part of child health and elderly surveillance programmes. There is also a need to identify a suitable means of educating patients about the appropriateness of attending their doctor (as an alternative to an A & E department) with minor trauma. There is scope for increased involvement of practice nurses in this field.