Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study

Cowling, Thomas E; Cecil, Elizabeth; Soljak, Michael; Lee, John Tayu; Millett, Christopher; Majeed, Azeem; Wachter, Robert M.; Harris, Matthew

doi:10.1371/journal.pone.0066699

Cited by 127 publications

(143 citation statements)

References 26 publications

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“…Visits to the various health settings were treated independently in the analysis, but they were likely linked as individuals with poor access to primary care may be more likely to visit an emergency department. 41 The lack of consensus in definitions of ''frequent visits'' makes the results of this study difficult to compare with the literature; however, using the 90th percentile to define the frequent visits group likely identified a group with high need and associated costs.…”

Section: Discussionmentioning

confidence: 86%

Frequency and characteristics of healthcare visits associated with chronic pain: results from a population-based Canadian study

Mann

Johnson

VanDenKerkhof

2016

Can J Anesth/J Can Anesth

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Purpose This study was designed to investigate the role of chronic pain in healthcare visits. The specific objectives were to document the frequency of healthcare visits and to identify characteristics associated with frequent visits. Methods This is a secondary analysis of data from a Canadian cross-sectional study on chronic pain. One thousand two hundred and ninety-four participants were screened for chronic pain, and 741 reported having ''pain or discomfort that had been experienced either all the time or intermittently for at least three months''. Data regarding sociodemographics, general health, and healthcare visits were also collected. The frequency of healthcare visits was defined as at or above the 90th percentile for the group. Frequency was calculated for each setting, i.e., physicians' offices (C 9), emergency departments (C 1), and other (C 15). Binary logistic regression analyses were conducted to identify factors associated with frequent visits.Results Chronic pain increased the frequency of visits to physicians (odds ratio [OR], 4.7; 95% confidence interval [CI], 2.8 to 7.9), emergency departments (OR, 1.4; 95% CI, 1.0 to 2.0), and ''other'' healthcare professionals (OR, 8.3; 95% CI, 4.5 to 15.5). Having C3 chronic conditions significantly increased the odds of frequent healthcare visits. Conclusion Interventions aimed at reducing healthcare costs for chronic pain should target individuals living with multiple chronic conditions. Research is needed to develop and test interventions that focus on the needs of these groups. Identifying the risk factors for high healthcare use and improving self-management may reduce healthcare visits. RésuméObjectif Cette étude a été conçue afin d'examiner le rô le de la douleur chronique dans les visites aux services de soins de santé. Les objectifs spécifiques de l'étude étaient de documenter la fréquence des visites et de déterminer les caractéristiques associées à des visites fréquentes. Méthode Cette étude est une analyse secondaire de données tirées d'une étude canadienne transversale sur la douleur chronique. Au total, 1094 patients ont été dépistés pour la douleur chronique, et 741 ont rapporté ressentir « des douleurs ou un inconfort perçus de façon continue ou intermittente pendant au moins trois mois ». Les données sociodémographiques ainsi que celles concernant la santé générale et les visites aux services de soins de santé ont également été colligées. La fréquence des visites aux services de soins de santé a été définie comme étant égale ou au-dessus du 90 e percentile pour le groupe et calculée pour chaque type de service, soit les docteurs et spécialistes (C 9), les départements d'urgence (C 1), et

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Section: Discussionmentioning

confidence: 86%

Frequency and characteristics of healthcare visits associated with chronic pain: results from a population-based Canadian study

Mann

Johnson

VanDenKerkhof

2016

Can J Anesth/J Can Anesth

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“…Cowling et al (2013) uses all GP practices in England where data is available (7,856 practices) while Bankart et al (2011) uses 145 practices in two Primary Care Trusts in the East-Midlands. Besides considering the accessibility of primary care, the two studies also look at additional covariates like distance of the practice to the nearest A&E, practice list size (number of registered patients), and demand for primary care services.…”

Section: Literature Reviewmentioning

confidence: 99%

Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening

Dolton

Pathania

2016

Journal of Health Economics

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Restricted access to primary care can lead to avoidable, excessive use of expensive emergency care. Since 2013, partly to alleviate overcrowding at the Accident & Emergency (A&E) units of hospitals, the UK has been piloting 7-day opening of General Practitioner (GP) practices to improve primary care access for patients. We evaluate the impact of these pilots on patient attendances at A&E. We estimate that 7-day GP opening has reduced A&E attendances by patients of pilot practices by 9.9% with most of the impact on weekends which see A&E attendances fall by 17.9%. The effect is non-monotonic in case severity with most of the fall occurring in cases of moderate severity. An additional finding is that there is also a 9.9% fall in weekend hospital admissions (from A&E) which is entirely driven by a fall in admissions of elderly patients. The impact on A&E attendances appears to be bigger among wealthier patients. We present evidence in support of a causal interpretation of our results and discuss policy implications.

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“…For example, difficulty getting a GP appointment has been shown to explain higher rates of attendance at EDs. 26,27 We undertook a three-block analysis to reflect this: l block 1: population-related factors: population, geography, health l block 2: out of hospital service-related factors -GP access, GP quality, ambulance service performance, GP OOH service l block 3: in hospital service-related factors: ED attendance, conversion rate at ED, short length of stay in hospital.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have found that perceived access to general practice affects ED attendance. 26,27 Less research has been undertaken on system-related factors, such as integration of health and social services. Two limited case studies suggested integration of services was associated with reduced increase in emergency admissions.…”

Section: Factors Affecting Emergency Admissionsmentioning

confidence: 99%

“…We included ED attendance rates, which in other studies were predicted by perceived access to general practice. 26,27 Therefore, the ED attendance rate may have been a measure of access to general practice in our regression. It is also worth noting that the relationship between poor perceived access to general practice and high use of EDs has not always been found.…”

Section: Four-hour Targetmentioning

confidence: 99%

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Explaining variation in emergency admissions: a mixed-methods study of emergency and urgent care systems

O’Cathain

Knowles

Turner

et al. 2014

Health Services and Delivery Research

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BackgroundRecent increases in emergency admission rates have caused concern. Some emergency admissions may be avoidable if services in the emergency and urgent care system are available and accessible. A set of 14 conditions, likely to be rich in avoidable emergency admissions, was identified by expert consensus.ObjectiveWe aimed to understand variation in avoidable emergency admissions between different emergency and urgent care systems in England.MethodsThe design was a sequential mixed-methods study in three phases. In phase 1 we calculated an age- and sex-adjusted avoidable admission rate for 2008–11. We located routine data on characteristics of emergency and urgent care systems and used linear regression to explain variation in avoidable admissions rates in 150 systems. In phase 2 we undertook in-depth case studies in six systems to identify further factors. A key part of these case studies was interviews with commissioners, service providers and patient representatives, totalling 82 interviews. In phase 3 we returned to the linear regression to test further factors identified in the case studies.ResultsThe 14 conditions accounted for 3,273,395 admissions in 2008–11 (22% of all emergency admissions). The mean age- and sex-adjusted admission rate was 2258 per year per 100,000 population, with a 3.4-fold variation between systems (1268–4359). Characteristics of the population explained the majority of variation: deprivation explained 72% of variation, with urban/rural status explaining 3% more. Systems serving populations with high levels of deprivation and in urban areas had high rates of potentially avoidable admissions. Interviewees described the complexity of deprivation, representing high levels of morbidity, low awareness of alternative services to emergency departments and high expressed need for immediate access to urgent care. Factors related to emergency departments (EDs), hospitals, emergency ambulance services and general practice explained a further 10% of variation in avoidable admissions. Systems with high, potentially avoidable, admission rates had high rates of acute beds (suggesting supply-induced demand), high rates of attendance at EDs (which have been associated with poor perceived access to general practice), high rates of conversion from ED attendances to admissions, and low rates of non-transport to emergency departments by emergency ambulances. The six case studies revealed further possible explanations of variation: there was variation in how hospitals coded admissions; some systems focused proactively on admission avoidance whereas others were more interested in hospital discharge, for example use of multidisciplinary teams based at acute trusts; there were different levels of integration between different services such as health and social care, and acute and community trusts; and some systems faced more challenging problems around geographical boundaries operating for different services in the system. Interviewees often described admission as the easy or safe option.ConclusionsDeprivation explained most of the variation in avoidable admission rates. Research is needed to understand the complex relationship between deprivation and avoidable admission, and to develop interventions tailored to avoid admissions from deprived communities. Standardisation of coding of admissions would reduce variation.FundingThe National Institute for Health Research Health Service and Research Delivery programme.

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Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study

Cited by 127 publications

References 26 publications

Frequency and characteristics of healthcare visits associated with chronic pain: results from a population-based Canadian study

Frequency and characteristics of healthcare visits associated with chronic pain: results from a population-based Canadian study

Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening

Explaining variation in emergency admissions: a mixed-methods study of emergency and urgent care systems

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