Impact of UK Primary Care Policy Reforms on Short-Stay Unplanned Hospital Admissions for Children With Primary Care-Sensitive Conditions

Abstract

PURPOSE We aimed to assess the impact of UK primary care policy reforms implemented in April 2004 on potentially avoidable unplanned short-stay hospital admissions for children with primary care-sensitive conditions. METHODSWe conducted an interrupted time series analysis of hospital admissions for all children aged younger than 15 years in England between April 2000 and March 2012 using data from National Health Service public hospitals in England. The main outcomes were annual short-stay (<2-day) unplanned hospital admission rates for primary care-sensitive infectious and chronic conditions. RESULTS There were 7.8 million unplanned admissions over the study period. More than one-half (4,144,729 of 7,831,633) were short-stay admissions for potentially avoidable infectious and chronic conditions. The primary care policy reforms of April 2004 were associated with an 8% increase in short-stay admission rates for chronic conditions, equivalent to 8,500 additional admissions, above the 3% annual increasing trend. Policy reforms were not associated with an increase in short-stay admission rates for infectious illness, which were increasing by 5% annually before April 2004. The proportion of primary care-referred admissions was falling before the reforms, and there were further sharp reductions in 2004. CONCLUSIONSThe introduction of primary care policy reforms coincided with an increase in short-stay admission rates for children with primary care-sensitive chronic conditions, and with more children being admitted through emergency departments. Short-stay admission rates for primary care-sensitive infectious illness increased more steadily and could be related to lowered thresholds for hospital admission.

Assessment of the essential attributes of Primary Health Care for children

“…The data collection in the present Claudia Silveira Viera E-mail: clausviera@gmail.com CORRESPONDING AUTHOR Las puntuaciones de los atributos esenciales con relación a la estructura son: Accesibilidad (5,5), Grado de afiliación (6,9), Integralidad -Servicios Disponibles (6,0) y Coordinación -Sistema de información (7,4). En cuanto al Proceso, se encuentran: Acceso de Primer Contacto -Utilización (8,6), Longitudinalidad (6,1), Integralidad -Servicios Prestados (6,1) y Coordinación -Integración de los Cuidados (6,9). Conclusión: La puntuación principal fue de 6,6 y la general, 6,3, demostrando una orientación precaria de la atención primaria a la salud.…”

“…Despite the transformations in health policies and guidelines directed at children, the scenario of child morbidity and mortality reveals a lack of articulation and Integrality of care, shown through the high rates of preventable child mortality (66.56%) and hospitalizations for preventable conditions (65.2%) (5)(6)(7)(8)(9) .…”

Primary Care Access, Emergency Department Visits, and Unplanned Short Hospitalizations in the UK

“…10 Certainly, short hospitalizations for chronic conditions have been positively associated with withdrawal of primary care. 11 Ambulatory caresensitive (ACS) conditions are defined as conditions for which hospitalization can be avoided by responsive and preventive primary care. Studies of ACS hospitalizations in children have used pediatric quality indicators 12,13 developed in the United States and the United Kingdom such as those of the Agency for Healthcare Research and Quality (AHRQ).…”

“…14 These indicators relate to limited specific conditions (eg, urinary tract infection, gastroenteritis, asthma, diabetes) accounting for <10% of highly frequent causes of hospitalization among children. 11 In addition, in the United Kingdom, pediatric diabetes is managed by specialist physicians and not by GPs. Hence, this smaller subset of conditions may underestimate the magnitude to which primary care accessibility could have an impact on health system pressures.…”

Behavioural innovation is key to improving the health of one million Australians living with type 2 diabetes

“…We estimate that 1.3 per cent of hospital admissions are potentially avoidable through substitution and better chronic A systematic review by Renom-Guiteras, et al (2014) highlighted the many factors which impact on admission decisions 105 Cecil, et al (2015) has also adopted a cut-off of less than two days as the criterion for preventability in primary care. disease management.…”