Do general practices provide equitable access to physical activity interventions?

Abstract

Exercise referral schemes are widespread across England. National guidance emphasises the need to engage groups that are disadvantaged. AimTo examine the influence of socioeconomic deprivation on referral to, and use of, exercise referral schemes. Design of studyCross-sectional analysis of patients referred by general practices to exercise referral schemes between 2004 and 2006. SettingSix primary care trusts (PCTs) in Greater London. MethodRoutine data about patients who had been referred to exercise referral schemes were used to estimate risk ratios for referral by general practice deprivation quintile, odds ratios (ORs) for uptake, and ORs for completion of exercise referral schemes by patients' deprivation status quintile. ResultsAll 317 general practices in the six PCTs were included in the referral analysis. Referrals were less likely from general practices serving advantaged socioeconomic areas (adjusted risk ratio for trend across deprivation quintiles 0.84; 95% confidence interval [CI] = 0.76 to 0.93). This study found no association between patients' deprivation status and their likelihood of taking up (adjusted OR, least versus most deprived quintile 1.05; 95% CI = 0.83 to 1.33) or completing the scheme (adjusted OR 1.23; 95% CI = 0.84 to 1.79). ConclusionGeneral practices within areas of deprivation were more likely to refer patients to exercise referral schemes than practices in more advantaged areas. Once referred, it was found that patients living in areas of deprivation were as likely to take up and to complete the scheme as those living in more advantaged locations. Research is needed to identify the organisational and contextual factors that allow this pattern of service delivery, which appears to facilitate access to care among patients who live in areas of deprivation. Keywordsexercise; family practice; health promotion; healthcare disparities; referral and consultation; socioeconomic factors. INTRODUCTIONExercise referral schemes are one of the most widely established primary care physical activity interventions in England (Box 1). 1 The majority of referrals to these schemes are made by general practices. 2National guidance emphasises the importance of ensuring that exercise referral schemes are delivered equitably and explicitly states that they should employ strategies to target and engage people from disadvantaged groups.2 Although people from such groups attend primary care more frequently than those from more advantaged socioeconomic groups 3 (which accords with their greater need for care) they are less likely to use preventative 4 and specialist 5,6 health services. This observation, that those in most need of health care are often the least well served in terms of receipt of such care, has been termed the 'inverse care law.' 7The benefits of physical activity for the primary and secondary prevention of a range of clinical conditions 8 underpin the eligibility criteria for exercise referral schemes.2 It is likely that there is higher eligibility for these schemes among patients from ...

Exercise on referral: evidence and complexity at the nexus of public health and sport policy

“…While this does not yet reach a consensus (Campbell et al 2015), extending the range of evidence considered by public health reviews may offer guidance for more targeted policy. For example, some ERS have been identified as more successful at engaging older individuals (Isaacs et al 2007;Hanson et al 2013), those living in a less deprived area (Gidlow et al 2007), or those referred from specific disease pathways (Sowden 2008;Dugdill 2005;Hanson et al 2013). At the least, guidelines should encourage attention to sub-group effects in both evaluations and by evidence users.…”

A systematic review and economic evaluation of exercise referral schemes in primary care: a short report

“…51 Increasing age was a factor that strongly predicted for both uptake of ERSs and adherence to the scheme in six studies. 6,23,24,38,49,51 Three studies found no such association. 18,42,47 Three studies 23,39,49 found that those most deprived were less likely to take up ERSs and two studies 23,49 found that deprivation was a predictor for not adhering to ERSs.…”

“…> 80% attendance). For four studies, [37][38][39][40] attendance at a post-ERS consultation was also required to meet the definition of adherence. The uptake of ERSs across the RCTs ranged from 35% to 100%.…”

“…Four studies 23,38,47,49 found that women were more likely to take up ERSs than men, but two studies 41,44 found no association between sex and uptake. The data for adherence, however, are less consistent, with one study 49 reporting that men are more likely to adhere to ERSs than women and another that women are more likely to adhere to ERSs.…”

The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation

“…). For four studies, 88,91,92,103 attendance at a post-ERS consultation was also required to meet the definition of adherence.…”