Exploration of population and practice characteristics explaining differences between practices in the proportion of hospital admissions that are emergencies

Abstract

BackgroundEmergency (unscheduled) and elective (scheduled) use of secondary care varies between practices. Past studies have described factors associated with the number of emergency admissions; however, high quality care of chronic conditions, which might include increased specialist referrals, could be followed by reduced unscheduled care. We sought to characterise practices according to the proportion of total hospital admissions that were emergency admissions, and identify predictors of this proportion.MethodThe study included 229 general practices in Leicestershire, Northamptonshire and Rutland, England. Publicly available data were obtained on scheduled and unscheduled secondary care usage, and on practice and patient characteristics: age; gender; list size; observed prevalence, expected prevalence and the prevalence gap of coronary heart disease, hypertension and stroke; deprivation; headcount number of GPs per 1000 patients; total and clinical quality and outcomes framework (QOF) scores; ethnicity; proportion of patients seen within two days by a GP; proportion able to see their preferred GP. Using the proportion of admissions that were emergency admissions, seven categories of practices were created, and a regression analysis was undertaken to identify predictors of the proportion.ResultsIn univariate analysis, practices with higher proportions of admissions that were emergencies tended to have fewer older patients, higher proportions of male patients, fewer white patients, greater levels of deprivation, smaller list sizes, lower recorded prevalence of coronary heart disease and stroke, a bigger gap between the expected and recorded levels of stroke, and lower proportions of total and clinical QOF points achieved. In the multivariate regression, higher deprivation, fewer white patients, more male patients, lower recorded prevalence of hypertension, more outpatient appointments, and smaller practice list size were associated with higher proportions of total admissions being emergencies.ConclusionIn monitoring use of secondary care services, the role of population characteristics in determining levels of use is important, but so too is the ability of practices to meet the demands for care that face them. The level of resources, and the way in which available resources are used, are likely to be key in determining whether a practice is able to meet the health care needs of its patients.

Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England

“…Most previous UK studies of continuity have been ecological in nature, involving aggregated data at the practice level, [11][12][13][14][15] meaning that associations cannot necessarily be applied to individual patients. The study of Barker et al 10 was one of the first in the United Kingdom to link continuity of care and number of hospital admissions using individual-level data.…”

“…[11][12][13][14][15] These ecological studies differ in their findings regarding the impact of continuity of care on (unplanned) hospital admission, however.…”

Continuity of primary care matters and should be protected

“…This finding builds upon results from ecological studies using practice level data to explore this relationship. [7][8][9][10][11] Barker and colleagues chose to focus on older patients (aged between 62 and 82 years) because they account for a high proportion of both primary care consultations and emergency hospital admissions. Their findings are therefore highly relevant internationally-because of demographic changes, most developed countries now have an increasingly elderly population with a high prevalence of multimorbidity.…”

Inequity in cardiovascular care in the English National Health Service (NHS): a scoping review of the literature

“…, Brettell et al . ), although there is some evidence that small practice size may play a role in variation (Wiseman & Baker ).…”

“…While these studies vary with respect to setting, there is no obvious methodological explanation of why their results are so inconsistent. Several studies have also looked at emergency admissions for cardiovascular disease and proposed that the lack of association between quality scores and admission rates suggests that the quality of primary care is not a significant factor behind higher rates of admission among the socially deprived (Downing et al 2007, Bottle et al 2008, Purdy et al 2011, Brettell et al 2013, although there is some evidence that small practice size may play a role in variation (Wiseman & Baker 2014).…”