Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data

Abstract

BackgroundThe 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.ObjectiveTo determine whether primary care access is associated with the route of emergency admission—via a GP versus via an A and E department.MethodsRetrospective 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.ResultsThe 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 <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England.ConclusionsAmong hospital inpatients admitted as an emergency, patients registered to more accessible general practices were more likely to have been admitted via a GP (vs an A and E department). This furthers evidence suggesting that access to general practice is related to use of emergency hospital services in England. The relative merits of the two admission routes remain unclear.

Extended opening hours in primary care: helpful for patients and—or—a distraction for health professionals?

“…In a previous study,8 the same group showed that patients who had an emergency hospital admission while registered to general practices with better access were more likely to be admitted via a general practitioner (GP) (vs an Accident and Emergency department). For each 5-unit increase in the percentage of patients able to obtain a general practice appointment on their last attempt, the odds of admission to hospital via their GP (vs through the emergency department) increased by 15% (OR 1.15, 95% CI 1.12% to 1.17%).…”

Navigating and making sense of urgent and emergency care processes and provision

“…People are required, often at the point when sick or injured, to distinguish between health‐care needs that are categorized as “routine,” “urgent,” “emergency,” “primary” or “acute” and are confronted by an array of possible services, to which access may vary according to time of day, and day of week. There is some suggestion that a key driver of ED attendance is lack of access to primary care services which may be a factor driving urgent care demand to EDs. However, a recent qualitative study exploring why patients choose to attend the ED suggested experiential knowledge of previous service use might be more relevant in decision making suggesting that people are not merely applying categories when making decisions to seek help.…”

Staff perceptions on patient motives for attending GP-led urgent care centres in London: a qualitative study

“…The lack of proper response from the primary care is well documented as one of the many reasons for increasing urgent care attendances. 11 13 14 31 47 But is increased access to urgent care facilities the right solution? Attention to unmet needs can guide on how community GPs can adjust to meet current patient needs.…”