Access to primary care and the route of emergency admission to hospital

Retrospective analysis of national hospital administrative data

Thomas E. Cowling, Matthew Harris, Hilary Watt, Michael Soljak, Emma Richards, Elinor Gunning, Alex Bottle, James Macinko, Azeem Majeed

Research output: Contribution to journalArticle

Abstract

Background The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPS and hospital doctors, possibly improving healthcare outcomes. Objective To determine whether primary care access is associated with the route of emergency admission-via a GP versus via an A and E department. Methods Retrospective analysis of national administrative data from English hospitals for 2011-2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access-the percentage of patients able to get a general practice appointment on their last attempt-was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. Results The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when

Original languageEnglish (US)
Pages (from-to)432-440
Number of pages9
JournalBMJ Quality and Safety
Volume25
Issue number6
DOIs
StatePublished - Jun 1 2016

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General Practitioners
Primary Health Care
Emergencies
General Practice
Hospital Emergency Service
Appointments and Schedules
Accidents
Patient Advocacy
Hospital Costs
Patient Admission
Logistic Models
Delivery of Health Care
Population

ASJC Scopus subject areas

  • Health Policy

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Access to primary care and the route of emergency admission to hospital : Retrospective analysis of national hospital administrative data. / Cowling, Thomas E.; Harris, Matthew; Watt, Hilary; Soljak, Michael; Richards, Emma; Gunning, Elinor; Bottle, Alex; Macinko, James; Majeed, Azeem.

In: BMJ Quality and Safety, Vol. 25, No. 6, 01.06.2016, p. 432-440.

Research output: Contribution to journalArticle

Cowling, TE, Harris, M, Watt, H, Soljak, M, Richards, E, Gunning, E, Bottle, A, Macinko, J & Majeed, A 2016, 'Access to primary care and the route of emergency admission to hospital: Retrospective analysis of national hospital administrative data', BMJ Quality and Safety, vol. 25, no. 6, pp. 432-440. https://doi.org/10.1136/bmjqs-2015-004338
Cowling, Thomas E. ; Harris, Matthew ; Watt, Hilary ; Soljak, Michael ; Richards, Emma ; Gunning, Elinor ; Bottle, Alex ; Macinko, James ; Majeed, Azeem. / Access to primary care and the route of emergency admission to hospital : Retrospective analysis of national hospital administrative data. In: BMJ Quality and Safety. 2016 ; Vol. 25, No. 6. pp. 432-440.
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