Objectives To identify characteristics of general practices associated with emergency hospital admission rates, and determine whether levels of performance and patient reports of access are associated with admission rates. Design A cross-sectional study. Setting Two primary care trusts (Leicester City and Leicestershire County and Rutland) in the East Midlands of England. Participants 145 general practices. Methods Hospital admission data were used to calculate the rate of emergency admissions from 145 practices, for two consecutive years (2006/7 and 2007/8). Practice characteristics (size, distance from principal hospital, quality and outcomes framework performance data, patient reports of access to their practices) and patient characteristics (deprivation, ethnicity, gender and age), were used as predictors in a two-level hierarchical model, developed with data for 2007/8, and evaluated against data for 2006/7. Results Practice characteristics (shorter distance from hospital, smaller list size) and patient characteristics (higher proportion of older people, white ethnicity, increasing deprivation, female gender) were associated with higher admission rates. There was no association with quality and outcomes framework domains (clinical or organisation), but there was an association between patients reporting being able to see a particular general practitioner (GP) and admission rates. As the proportion of patients able to consult a particular GP increased, emergency admission rates declined. Conclusions The patient characteristics of deprivation, age, ethnicity and gender are important predictors of admission rates. Larger practices and greater distance from a hospital have lower admission rates. Being able to consult a particular GP, an aspect of continuity, is associated with lower emergency admission rates.In this paper, we report a study of the characteristics of general practices associated with the rate of emergency hospital admissions. The definition of emergency admissions in this study is that used in the English health service as including all non-elective admissions, including those via emergency departments, general practitioners, outpatient departments and other providers. In England in 2008e9 there were 14.1 million new hospital admissions, of which 5.0 million (35.4%) were emergency admissions, an increase of 22% on the 3.9 million emergency admissions in 2000e1.

Access to general practice, anxiety about the presenting problem, awareness and perceptions of the efficacy of the services available in the ED and lack of alternative pathways are important predictors of attendance rates.

Performance as indicated by the quality and outcomes framework did not predict rates of attendance at emergency departments, but satisfaction with telephone access did. Consideration should be given to improving access to some general practices to contain the use of emergency departments.

BackgroundHerbal Medicines (HMs) are playing major roles in the health of the millions of people worldwide. Muslim Religious Leader (MRLs), being an important component of the society with huge influence on it, could contribute a lot to promote HM. This study was aimed at evaluating perceptions of the MRLs, their satisfaction and attitudes towards HM in Bangladesh.MethodsThis cross-sectional study collected data from a purposive sample of 503 MRLs using an interviewer-administered structured questionnaire during December 2010 and January 2011. Main outcome measures included sociodemographic variables, MRLs' preferences in using HMs, their satisfaction and intent to use HMs in the future, and finally MRLs' attitudes toward HM use.ResultsAlthough two-fifth (40.4%) of the MRLs preferred HM among different form of complementary and alternative medicines, they used orthodox medicine (OM) more frequently than HM in last one year. Majority believed that HM was effective for all age groups (52.6%) and both sexes (74.5%). One-third felt that HM was more effective for chronic diseases, 68.5% felt that it only promotes health, and 40.8% said it keeps them relaxed. About 98.0% of the respondents experienced 'no harm' but 'benefit' from HM; naturally, they were satisfied with HM and were willing to recommend it to others. Urban, older (>40 years), and 'single' respondents were more likely to use HM (gender and education adjusted odds ratios = 1.7 [95% confidence interval, CI = 1.1-2.6], 1.9 [95% CI = 1.3-3.0], and 1.6 [95% CI = 1.2-2.1], respectively). Overall, respondents exhibited very positive attitude towards HM with mean score of 4.2 (range, 3.7-4.6) of a 5-point Likert scale (Score 5 for strongly agree to 1 for strongly disagree).ConclusionsWe report adequate perceptions, satisfaction, and very positive attitudes towards HM among MRLs. Mass media had a significant contribution towards its promotion. If HM are to assume a respected place in the contemporary healthcare, its acceptance among general population needs to be established through incorporating MRLs in the process of HM promotion in Bangladesh.