Do difficulties in accessing in-hours primary care predict higher use of out-of-hours GP services? Evidence from an English National Patient Survey

Abstract

IntroductionIt is believed that some patients are more likely to use out-of-hours primary care services because of difficulties in accessing in-hours care, but substantial evidence about any such association is missing.MethodsWe analysed data from 567 049 respondents to the 2011/2012 English General Practice Patient Survey who reported at least one in-hours primary care consultation in the preceding 6 months. Of those respondents, 7% also reported using out-of-hours primary care. We used logistic regression to explore associations between use of out-of-hours primary care and five measures of in-hours access (ease of getting through on the telephone, ability to see a preferred general practitioner, ability to get an urgent or routine appointment and convenience of opening hours). We illustrated the potential for reduction in use of out-of-hours primary care in a model where access to in-hours care was made optimal.ResultsWorse in-hours access was associated with greater use of out-of-hours primary care for each access factor. In multivariable analysis adjusting for access and patient characteristic variables, worse access was independently associated with increased out-of-hours use for all measures except ease of telephone access. Assuming these associations were causal, we estimated that an 11% relative reduction in use of out-of-hours primary care services in England could be achievable if access to in-hours care were optimal.ConclusionsThis secondary quantitative analysis provides evidence for an association between difficulty in accessing in-hours care and use of out-of-hours primary care services. The findings can motivate the development of interventions to improve in-hour access.

Telephone triage for management of same-day consultation requests in general practice (the ESTEEM trial): a cluster-randomised controlled trial and cost-consequence analysis

“…The absence of an increase in attendance in accident and emergency departments or in use of out-of-hours GP services after introduction of either GP triage or nurse triage suggests that triage is not regarded as a suffi cient barrier that could result in patients seeking care outside of their practice; 26 nor does easier access to telephone advice in general practice seem to reduce patient contacts in other settings. Introduction of nurse triage was associated with a reduction in overall patient satisfaction, but more substantial reductions in some individual components of satisfaction were suggestive of patients' experience of care.…”

Emergency hospital admissions for asthma and access to primary care: cross-sectional analysis

“…29 Several of these access questions have been used in other research as proxies for markers of patient access to surgery, although the composite access score has not yet been used as a research tool. [18][19][20][21][22][23][24] Further independent variables that have been shown to be associated with variation in practice-level performance in previous studies in English primary care were identified. These were: the size of the practice measured in numbers of patients in 2010; and the GP Practice Index of Multiple Deprivation (IMD 2010, rank), which is estimated by taking a weighted average of the IMD scores for each Lower Super Output Area (LSOA) in which a given practice has registrations.…”

“…27 The dependent variable was the rate of emergency admissions for asthma per 1000 patients on the asthma register, for each general practice. The codes for emergency admission were the PBR tariff 21,22,23,24,28; the ICD-10 primary diagnoses codes for asthma were J45-J46.…”

“…[18][19][20][21][22][23] Similar associations have been seen for access to primary care services and accident and emergency department use, and higher use of out-of-hours services. 24,25 It is hypothesised that better access to primary care is associated with reduced emergency admission rates for asthma.…”

Utilising out-of-hours primary care for assistance with cancer pain: a semi-structured interview study of patient and caregiver experiences

“…14,15 For example, difficulties in accessing in-hours care are known to predict higher use of primary care OOH services. 16 This study explored the experiences, views, and opinions of patients with cancer and their caregivers who had used an OOH primary care service for assistance with pain management. Interviews explored the circumstances prompting OOH contacts relating to pain, experiences of daytime care, and participants' experiences of using OOH primary care services for help with cancer pain management.…”