Service Users Research Articles

An observational study of socioeconomic disparities in psychiatry consultation uptake in Australia, using routinely collected national data from 2015 to 2022.

The COVID-19 pandemic was associated with increased psychological distress and psychiatric service usage in Australia. Previous research into the first few months of the pandemic found severe inequality in telehealth psychiatry but no change in inequality for psychiatry service usage overall. However, it is unknown how inequality evolved over the remainder of the pandemic, as extended lockdowns continued in major Australian cities. To understand how socioeconomic inequality in psychiatric consultations changed during the COVID-19 pandemic, using new data from 2020 to 2022. We analysed routinely collected national Medicare data, provided to us as service counts per Statistical Area 3 (SA3) region by financial year from 2015 to 2016 to 2021 to 2022. We calculated daily rates of psychiatry attendances per 100,000 working age adults within each SA3 region, and we evaluated inequality in the distribution of consults using concentration indices and curves based on the Index of Relative Socio-economic Disadvantage (IRSD). We analysed 7 years of Medicare data from 321 SA3 regions. The national consultation rate increased in 2020 to 2021 from 45.16 to 50.17, and then decreased slightly in 2021 to 22 to 48.65. Inequality as measured by concentration indices rose from 0.169 in 2020 to 2021 to 0.177 in 2021 to 2022. Consultation rates in the most disadvantaged IRSD quintile decreased by 15.9% in 2021 to 2022 compared to smaller decreases of between 1% and 4% in the top 4 quintiles. Our study shows that inequality in mental health service provision increased in the second year of the COVID-19 pandemic to the highest level seen in the 7 years of data we analysed. Individuals within the most disadvantaged IRSD quintile experienced a significant and disproportionate decline in service rates. Close monitoring and more granular data are needed to understand the drivers behind this inequity and its current status, and to inform interventions to improve it.

Descriptive analysis of interpreter service mode costs & usage in Northwestern Wisconsin pre and peri COVID-19

BackgroundInterpreter service mode (in person, audio, or video) can impact patient experiences and engagement in the healthcare system, but clinics must balance quality with costs and volume to deliver services. Videoconferencing and telephone services provide lower cost options, effective where on site interpreters are scarce, or patients with limited English proficiency (LEP) and/or interpreters are unable to visit healthcare centers. The COVID 19 pandemic generated these conditions in Northwest Wisconsin (NWWI). The objectives of our study were to describe visit characteristics for interpreter services pre and peri COVID-19 and how interpreter visits and costs differed by modality and language pre and peri COVID-19 at Mayo Clinic Health System (MCHS) Eau Claire and Menomonie, Wisconsin (WI).MethodsWe analyzed medical records and billing data from MCHS Eau Claire and Menomonie that included interpretation visit characteristics and aggregate costs. We performed descriptive analysis of visit characteristics and aggregate costs (dependent variables: cost, duration, language, modality, payer type, department, patient age, and patient biological sex) from June-December 2019, 2020 (independent variables). We used Pearson’s chi-square and t tests to test for significant differences in visit characteristics between time periods.ResultsSignificant differences were found in distribution of all visit characteristics (language, p-value < .001; biological sex, p-value .011; mode, p-value < .001; payer type, p-value < .001; department, p-value < .001; age, p-value .016; visit duration in hours, p-value < .001) between 2019 and 2020 windows. Total costs of all interpretation modes increased between 2019 (in person, $188,109; audio, $15,734; video $15,881) and 2020 (in person, $388,500; audio, $44,376; video, $34,245) despite similar visit counts for both years (2019, 3750 visits; 2020, 3425 visits). Differences between years are consistent with COVID-19 protocols, department usage by language, and patient age.ConclusionsOur results show similar counts in the number of overall visits and increase in interpreter service costs in all modes, positively reflecting upon the availability of multimodal language resources.

Building User Loyalty Through Excellence Administrative Services in Private Higher Education

This study investigates the quality of administrative services and their impact on the loyalty of educational service users at Islamic colleges in Riau Province. The objectives are: (1) to evaluate the existing quality of administrative services; (2) to assess the level of user loyalty; and (3) to identify aspects of administrative services that can enhance user loyalty. Using a qualitative descriptive-analytical approach, data were collected through observations, interviews, and documentation, and analyzed using the Miles and Huberman model with data triangulation for validation. The findings reveal that the quality of administrative services at three private Islamic colleges in Riau Province has not successfully increased user loyalty. Contributing factors include a lack of institutional commitment, unresponsive and unfriendly administrative staff, inaccurate data handling, and inadequate service facilities. To improve user loyalty, administrative services must address user needs and expectations by ensuring responsive, accurate, and high-quality service delivery.

A Mobile Health Intervention to Support Collaborative Decision-Making in Mental Health Care: Development and Usability.

Shared decision-making between clinicians and service users is crucial in mental health care. One significant barrier to achieving this goal is the lack of user-centered services. Integrating digital tools into mental health services holds promise for addressing some of these challenges. However, the implementation of digital tools, such as mobile apps, remains limited, and attrition rates for mental health apps are typically high. Design thinking can support the development of tools tailored to the needs of service users and clinicians. This study aims to develop and beta test a digital tool designed for individuals with severe mental disorders or substance use disorders to facilitate shared decision-making on treatment goals and strategies within mental health services. We used a user-centered design approach to develop iTandem, an app facilitating collaborative treatment between service users and clinicians. Through qualitative interviews and workshops, we engaged 6 service users with severe mental disorders or substance use disorders, 6 clinicians, and 1 relative to identify and design relevant app modules. A beta test of iTandem was conducted to refine the app and plan for a pilot trial in a clinical setting. After 6 weeks of app use, 5 clinicians and 4 service users were interviewed to provide feedback on the concept, implementation, and technical issues. Safety and ethical considerations were thoroughly discussed and addressed. To avoid overload for the service users, we applied a pragmatic take on module content and size. Thus, iTandem includes the following 8 modules, primarily based on the needs of service users and clinicians: Sleep (sleep diary), Medication (intake and side effects), Recovery (measures, including well-being and personal recovery, and exercises, including good things and personal strengths), Mood (mood diary and report of daily feelings), Psychosis (level of positive symptoms and their consequences and level of negative symptoms), Activity (goal setting and progress), Substance use (weekly use, potential triggers or strategies used to abstain), and Feedback on therapy (of individual sessions and overall rating of the past week). For the beta testing, service users and clinicians collaborated in choosing 2-3 modules in iTandem to work with during treatment sessions. The testing showed that the app was well received by service users, and that facilitation for implementation is crucial. iTandem and similar apps have the potential to enhance treatment outcomes by facilitating shared decision-making and tailoring treatment to the needs of service users. However, successful implementation requires thorough testing, iterative development, and evaluations of both utility and treatment effects. There is a critical need to focus on how technology integrates into clinical settings-from development to implementation-and to conduct further research on early health technology assessments to guide these processes.

Efficient and Secure Traffic Scheduling Based on Private Sketch

In today’s data–driven world, the explosive growth of network traffic often leads to network congestion, which seriously affects service performance and user experience. Network traffic scheduling is one of the key technologies to deal with congestion problems. Traditional traffic scheduling methods often rely on static rules or pre–defined policies, which make it difficult to cope with dynamically changing network traffic patterns. Additionally, the inability to efficiently manage tail contributors that disproportionately contribute to traffic can further exacerbate congestion issues. In this paper, we propose ESTS, an efficient and secure traffic scheduling based on private sketch, capable of identifying tail contributors to adjust routing and prevent congestion. The key idea is to develop a randomized admission (RA) structure, linking two count–mean–min (CMM) sketches. The first CMM sketch records cold items, while the second, following the RA structure, stores hot items with high frequency. Moreover, considering that tail contributors may leak private information, we incorporate Gaussian noise uniformly into the CMM sketch and RA structure. Experimental evaluations on real and synthetic datasets demonstrate that ESTS significantly improves the accuracy of feature distribution estimation and privacy preservation. Compared to baseline methods, the ESTS framework achieves a 25% reduction in average relative error and a 30% improvement in tail contributor identification accuracy. These results underline the framework’s efficiency and reliability.

“I am a clinician, but I’m also a service user…” Navigating doctoral training as a trainee clinical psychologist (TCP) with lived mental health experience (LMHE)

Purpose Lived mental health experience (LMHE) is a term describing the direct impact of a mental health problem or being a mental health carer. This study aims to qualitatively explore how UK-based trainee clinical psychologists with LMHE navigate doctoral training. Design/methodology/approach Trainee clinical psychologists (TCPs; N = 12) who self-reported LMHE completed a semi-structured interview which was analysed using constructivist grounded theory (CGT). Findings The end model had six main categories: the pressured system; narratives about LMHE within the profession; developing trainee identity and sense of self; disclosing LMHE within the professional context; building safe, balanced and reciprocal relationships with other professionals; drawing upon LMHE within clinical practice. The end model is visually depicted as an hourglass to represent receiving and internalising external information which influences identity development and bidirectionally filters outwards to shape interactions and relationships. Social implications Findings have implications for TCPs, course centres and using trusts. Originality/value To the best of the authors’ knowledge, this is the first CGT study to qualitatively explore how TCPs with LMHE navigate the holistic trajectory of doctoral clinical psychology training.

Bridging worlds: Unveiling challenges in community interpreting in Israel

This study examines the challenges involved in community interpreting in multicultural social services in Israel. Based on 20 semi-structured interviews with interpreters and social workers working with Ethiopian and French immigrants, the findings reveal three types of challenges: translation of sensitive content, ethical issues, and interpreter employment policy. Consequently, the study suggests employing the concept of ‘experiential knowledge’ to understand the complexity of the triadic relationship among social workers, interpreters, and service users. In this way, it illustrates the power relations at the intersection of different types of knowledge in professional interventions and makes recommendations for linguistic-sensitive social work.

Embedding Service User Experience ('Experts by Experience') Into Undergraduate Mental Health Nursing Education: A Co-Production Research Project.

Internationally, the need to have service user involvement (the 'voice' of recovery journeys) as an established and significant feature on the landscape of professional development has been widely discussed in the area of mental health nursing (MHN) education for over a decade. Service user involvement contributes to a different understanding, bringing 'new' ways of knowing in nursing education and potentially new ways of practicing within mental health services. The objective of this co-produced research was to investigate the current local 'state of play' of service user involvement in MHN student education in a regional university in the Republic of Ireland. This was not research 'on' participants as conventionally conceived, but rather research 'with' participants as co-researchers. Therefore, a group of people [i.e., 'experts by experience/service users' (n = 2), 'student nurses' (n = 2), 'nurse academics' (n = 2)], came together by agreement in recognition of a problem (service user engagement in education) to seek local knowledge and through 'creative dialogue' to identify potential improvements/developments. The key outcomes concentrated on the need for person-centred care to be more than a one-off lecture in a course, but to be central to MHN education and ongoing practice. The need for MHNs to be educated to grasp that the individual they work with is not 'an island', but is connected to a wider network of family, friends and potentially peer support workers, etc. is highlighted. To enhance MHN education going forward, there is a need for 'lived experience' to be a consistent element of education programmes. Achieving this will require stable working relationships with the establishment of career pathways for 'experts by experience' to develop skills and experience in education settings. The pace of culture change in MHN education is sporadic at best and downright slow at worst. However, a lot has been done, but there is more to do: 'We've come a long way, but we still have a long way to go…'.

Pulmonary rehabilitation healthcare professionals understanding and experiences of the protected characteristics of service users: A qualitative analysis.

Health inequalities can affect access and uptake to pulmonary rehabilitation (PR). An individual's protected characteristics (age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation) may contribute to health inequalities. Healthcare professionals (HCPs) experiences of the inclusivity and representativeness of PR services and knowledge of protected characteristics are unknown, however are vital for the identification and resolution of health inequalities. This qualitative study explored HCPs understanding of protected characteristics and their perception of the inclusivity, representativeness and equitable benefit of their PR services. Semi-structured qualitative interviews were conducted in person or via videoconferencing with HCPs involved in PR from two healthcare providers. Interviews were analysed using reflexive thematic analysis. 12 interviews were conducted with physiotherapists (n = 6), occupational therapists (n = 2), nurses (n = 2) and exercise physiologists (n = 2). Participants had a median (IRQ) age of 43 (13) and 75% (n = 9) were female. Four themes were generated. 1: 'I don't really know as much as I should' [about protected characteristics]; 2: It's uncomfortable collecting protected characteristics…; 3: 'I don't think [service users] are as representative as they could be'; 4: A conventional rehabilitation programme does not meet the needs of all. This study highlighted several challenges in HCPs understanding of protected characteristics and the representativeness of PR that must be addressed to ensure equity. Strategies, to understand barriers in accessing PR that limit representativeness should be explored.

“Hey librarian, what can AI and analytics do for you”: a systematic literature review and sociotechnical perspective

PurposeThis study aims to provide an in-depth overview of current research on artificial intelligence (AI) and analytics applications in library operations, emphasizing their adoption’s technical and social implications.Design/methodology/approachThe study follows the PRISMA guidelines to synthesize existing research on AI and analytics in academic libraries. This review uses sociotechnical systems (STS) theory as a framework to evaluate the technical aspects and social dynamics involved in integrating these technologies.FindingsThe findings indicate that AI and analytics can significantly enhance library resource management, decision-making and user services. However, ethical, social and technical challenges, including staff training and collaboration, must be addressed to ensure responsible implementation.Originality/valueThis study provides the first STS-informed analysis focusing on applying AI and analytics within academic library operations. It offers actionable insights into these technologies’ unique applications and potential, bridging a gap in the literature on library-specific operational management.

Assessing the physical health of service users with severe mental illness

Assessing the physical health of service users with severe mental illness

Commentary on how occupational therapists, physiotherapists and speech and language therapists can benefit from Precision Teaching

Purpose This paper aims to expand the arguments put forth by (Van and Kubina, 2024) and discuss Precision Teaching (PT)’s role within allied health professions (AHPs). Design/methodology/approach With services by AHPs becoming increasingly difficult to access, the need to accurately measure the efficacy of any input, however, limited, is a matter of priority, both for the sake of the service user and to ensure ongoing public funding of these professions. This commentary provides current clinical examples of the challenges faced by these professions. Findings The author discusses the use of PT as a way of ensuring the skills of AHPs are used as efficiently as possible. Originality/value Practical implications are discussed.

Feasibility of providing Sexually Transmitted Infection and Blood Borne Virus testing in a UK probation setting: findings from a service evaluation

BackgroundEarly diagnosis and treatment of Sexually Transmitted Infections (STIs) and Blood Borne Viruses (BBVs) remain strategic priorities for health services in the UK. Reaching those at high risk, including people in contact with the justice system, remains a key challenge in the diagnosis and treatment of STIs and BBVs. One setting that is yet to be used in the UK to identify STIs and BBVs is probation. Our objective was to examine whether a probation site (PS) is an acceptable and accessible setting for the provision of STI and BBV tests.MethodsIntervention. Testing for STIs and BBVs was offered to probation users attending a local probation setting in Wales, UK. Testing was offered via three methods: a finger-prick dried blood spot test, Rapid POCT oral swab, or finger-prick PCR micro-capillary finger prick test.Evaluation. Semi-structured interviews were used to provide insights from the testing team and probation staff who delivered and supported the testing service.ResultsThe programme was offered to all service users attending the PS over 18 working days. In total, 439 people were tested, 56% of whom had no previous record of being screened in Wales. Nine infections were identified and the majority of these were in people who appeared not to have previously accessed testing. Nine factors that affected uptake were identified. These included PS staff buy in, the location of the services, consistency, and empathy. Treatment uptake and completion rates were high for all infections.ConclusionsThis pilot study demonstrated that probation is an effective and acceptable setting to provide STI and BBV testing. The programme reached many people who had not previously accessed testing. It also showed that treatment completion rates were high amongst those who tested positive.

Replacing Car Trips with a Cargo Bike Sharing Service: What Features Do Users Value Most?

While cargo bikes are becoming an increasingly popular alternative to larger, more polluting vehicles in both the logistics and private mobility sectors, there has been comparatively little research on their use for private mobility. The potential of shared cargo bikes to replace car trips has been examined in some studies, but no previous research has investigated the critical factors that make it a valued alternative. By studying users’ willingness to pay, this paper examines the perceived value of a free cargo bike sharing service for users. The research is based on a survey of 321 users of the Fietje cargo bike sharing service in Bremen, conducted in 2022. In this sample, 38 to 55% of shared cargo bikes trips would otherwise have been performed by car. The paper identifies the transport of objects and children as critical features that provide value to users and create the potential to replace car trips. The results also draw attention to the fact that a cargo bike sharing service is likely to be a more effective tool for reducing car use if it is free. Introducing a fee would increase car trips by 14 to 18% of the total trips enabled by the service.

The implementation of safer drug consumption facilities in Scotland: a mixed methods needs assessment and feasibility study for the city of Edinburgh

BackgroundScotland currently has amongst the highest rates of drug-related deaths in Europe, leading to increased advocacy for safer drug consumption facilities (SDCFs) to be piloted in the country. In response to concerns about drug-related harms in Edinburgh, elected officials have considered introducing SDCFs in the city. This paper presents key findings from a feasibility study commissioned by City of Edinburgh Council to support these deliberations.MethodsUsing a multi-method needs assessment approach, we carried out a spatial and temporal analysis of drug-related data in Edinburgh including health, mortality, consumption, crime and service provision indicators; and 48 interviews including 22 people with lived/living experience (PWLE) of drug use in the city, five family members affected by drug-related harms, and 21 professional stakeholders likely to be involved in commissioning or delivering SDCFs. Data were collected using a convergent parallel design. We carried out a descriptive analysis of quantitative date and a thematic analysis of qualitative data. Quantitative data provides an overview of the local context in terms of recorded harms, service provision and consumption patterns as reported in prior surveys. Qualitative PWLE and families data captures the lived experiences of people who use drugs, and affected loved ones, within that local context, including perceived consumption trends, views on the practicality of SDCF provision, and hopes and anxieties regarding potential service provision. Professional stakeholders data provides insights into how people responsible for strategic planning and service delivery view the potential role of SDCF provision within the context described in the quantitative data.ResultsIn Edinburgh, drug-related harms and consumption patterns are dispersed across multiple locations, with some areas of higher concentration. Reported levels of opioid use, illicit benzodiazepine use and cocaine injecting are high. Qualitative interviews revealed strong support for the provision of SDCFs, and a preference for services that include peer delivery. However, PWLE also expressed concerns regarding safety and security, and professional stakeholders remained uncertain as to the prioritisation of facilities and possible opportunity costs in the face of restricted budgets.ConclusionThere is a strong case for the provision of SDCFs in Edinburgh. However, service design needs to reflect spatial distributions of consumption and harm, patterns of consumption by drug type, and expressed preferences for both informality and security among potential service users. Models of SDCF provision used elsewhere in Scotland would therefore need to be adapted to reflect such considerations. These findings may apply more broadly to potential SDCF provision in the UK and internationally, given changing patterns of use and harm.

Research on the construction of intelligent-aided design platform for green buildings

While socio-economic development and technological advancement bring great convenience to our life, energy consumption and environmental pollution have also become the core issues affecting human survival and development. This study focuses on the development of an intelligent design platform for green buildings, aimed at promoting sustainability through low energy consumption and reduced environmental impact. The study of existing national standards and requirements for the intelligent design of green buildings, combined with the unique characteristics of green buildings and user needs, has led to the development of an optimized auxiliary design platform system. By incorporating algorithm optimization and modeling techniques, this platform enhances the design process. Experimental evaluations of the system reveal that the intelligent auxiliary design offers more accurate predictions, thereby improving user service and experience. Additionally, the system contributes to energy efficiency and environmental sustainability by reducing the building’s ecological footprint. This research highlights the potential of intelligent systems to facilitate more efficient and environmentally friendly green building designs.

Supported everyday citizenship: widening the discourse to include persons living with intellectual disability or dementia

ABSTRACT In this article, we focus on supported everyday citizenship to widen the discourse of citizenship including persons living with intellectual disability or dementia. Support in everyday contexts is an essential aspect of social work practices. Supported everyday citizenship is defined as a relational concept for enhancing the social and political participation of persons with disabilities in need of welfare services. The idea can be traced back to five existing bodies of knowledge. These are (1) supported decision-making, (2) sociology of the everyday, (3) lived citizenship, (4) inclusive citizenship and (5) human rights. In this article, we approach supported everyday citizenship as a unifying perspective and lens through which the relationalities of persons with an intellectual disability or dementia can be understood in a welfare context. As such, the article adds to the current debates within professional practice and social work studies by exploring how supported everyday citizenship can be reconsidered and strengthen equal citizenship for persons who are service users.

An Integrated Two-Step Optimization Model and Aggregative Multi-Criteria Approach for Establishing Sustainable Tram Transportation Plan

The choice of the most appropriate sustainable scheme for the organization of tram transportation in cities is of great importance for tram operators, for users of transportation services, and for the protection of the environment from harmful emissions. This study aims to propose a methodology for formulating a tram transportation plan considering technological, environmental, economic, and social indicators. The variant schemes represent the routes of a tram in the tram network. The methodology includes four stages. The first stage involves the determination of variant schemes for a transportation plan of service with trams. In the second stage, a two-step optimization model is proposed to determine the number and trams by types for each tram route for each variant scheme, and also to establish the distribution of trams by depots. The third stage includes ranking the variant schemes by applying the sequential interactive model for urban systems (SIMUS) multi-criteria method. Eleven quantitative and qualitative criteria for evaluating the tram transportation plan were introduced. A verification of the results is performed in the fourth stage. For this purpose, a comparison of the preference ranking organization method for enrichment of evaluations (PROMETHEE) method and the technique for order of preference by similarity to ideal solution (TOPSIS) method is made. Both methods have different approaches for decision making and differ from the SIMUS method. Two strategies were proposed to determine the criteria weights. One is based on the Shannon entropy method and the other uses the objective weights obtained through the SIMUS method. Finally, in the fifth stage, the results obtained through the SIMUS, PROMEHEE and TOPSIS methods are combined using the expected value obtained by applying the program evaluation and review technique method (PERT). The proposed methodology was applied to study tram transportation in Sofia, Bulgaria. Five variant schemes were considered. The schemes are optimized through the criterion of minimum energy consumption. The number of trams by routes and by type was determined. An improved scheme for tram transportation in Sofia was proposed. The scheme makes it possible to increase the frequency of the trams by 13%, to reduce the zero mileage of rolling stock, and to reduce carbon dioxide pollution by 11%.

Older people’s social work safe staffing supply and workforce demands analysis: A case study from Northern Ireland

Abstract In the UK, a range of operational tools and policy guidelines regulate staffing in various Health and Social Care sectors. Nonetheless, frameworks to ensure safe staffing in social work remain less advanced. This study focuses on older people’s social work community teams in Northern Ireland due to the high volume of cases and vacancies within these teams. Our findings provide evidence based on actual caseloads (direct work with service users) and workloads at individual, team, and regional levels within this programme of care. The analysis revealed systemic issues that require systemic solutions in relation to staffing supply and service demands. Frontline social workers and managers frequently faced overwhelming worker-to-caseload ratios, routine use of waiting lists, and team vacancies. These findings lay the groundwork for evidence-based strategic planning, guiding the development and enactment of safer and more effective social work policies and legislation in the years ahead. The project was commissioned by the Department of Health, Northern Ireland in preparation for policy and legislative developments expected between 2025 and 2028.

Service evaluation of 'GP at Door' of accident and emergency services in Eastern England.

We describe activity, outcomes, and benefits after streaming low urgency attenders to General practice services at Door of Accident and Emergency departments (GDAE). Many attendances to A&Es are for non-urgent health problems that could be better met by primary care rather than urgent care clinicians. It is valuable to monitor service activity, outcomes, service user demographics, and potential benefits when primary care is co-located with A&E departments. As a service evaluation, we describe and analyse GDAE users, reasons for presentation, wait times, outcomes, and co-located A&E wait times at two hospitals in eastern England. Distributions of outcomes, wait times, reasons for attendance, deprivation, and age groups were compared for GDAE and usual A&E attenders at each site using Pearson chi-square tests and accelerated time failure modelling. Performance in a four-hour key performance indicator was descriptively compared for co-located and similar emergency departments. Each GDAE saw about 1025 patients per month. Wait times for usual accident and emergency (A&E) care are relatively short at only one site. Reattendances were common (about 11% of unique patients), 75% of GDAE attenders were seen within 1 hour of arrival, 7% of patients initially allocated to GDAE were referred back to A&E for further investigations, and 59% of GDAE patients were treated and discharged with no further treatment or referral required. Pain, injury, infection, or feeling generally unwell each comprised > 10% of primary reasons for attendance. At James Paget University Hospital, 4.3%, and at Queen Elizabeth Hospital, 16.1% of GDAE attendances led to referral to specialist health services. GDAE attenders were younger and more socially deprived than attenders to co-located A&Es. Patients were seen quickly at both GDAE sites, but there were differences in counts of specialist referrals and wait times. Process evaluation could illuminate reasons for differences between study sites.