Modelling factors in primary care quality improvement: a cross-sectional study of premature CHD mortality

Honeyford, Kate; Baker, Richard; Bankart, M John; Jones, David R.

doi:10.1136/bmjopen-2013-003391

Cited by 12 publications

(22 citation statements)

References 25 publications

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“…These findings are in harmony with previous findings on association between GMP level premature mortality and socioeconomic status [21][22][23] and urban setting [24].…”

Section: Observations In International Contextsupporting

confidence: 91%

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Association Between the General Practitioner Workforce Crisis and Premature Mortality in Hungary: Nationwide Evaluation of Health Insurance Data from 2006 to 2014

Sándor¹,

Pálinkás²,

Vincze³

et al. 2018

Preprint

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The workforce crisis of primary care is reflected in the increasing number of general medical practices (GMP) with vacant general practitioner (GP) position, and the GPs’ ageing. Our study aimed to describe the association between this crisis and premature mortality. Age-sex-standardized mortality for 18-64 years old adults were calculated for all Hungarian GMPs annually in the period from 2006 to 2014. The relationship of premature mortality with GPs’ age and vacant GP position were evaluated by standardized linear regression controlled for list size, urbanization, geographical location, clients’ education, and type of the GMP. The clients’ education was the strongest protective factor (beta=-0175; p<0.001), followed by urban residence (beta=-0.149; p<0.001), and the bigger list size (beta1601-2000=-0.054; p<0.001; beta2001-X=-0.096; p<0.001). The geographical localization influenced significantly also the risk. Although, GMP with a GP aged older than 65 years (beta=0; p=0.995) did not affected the risk, GP vacancy was associated with higher risk (beta=0.010; p=0.033), but the corresponding number of attributable cases was 23.54 for 9 years. The vacant GP position is associated with significant but hardly detectable increased risk of premature mortality without considerable public health importance. Nevertheless, employment of GPs aged more than 65 does not impose premature mortality risk elevation.

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“…These findings are in harmony with previous findings on association between GMP level premature mortality and socioeconomic status [21][22][23] and urban setting [24].…”

Section: Observations In International Contextsupporting

confidence: 91%

“…Our results, demonstrated that temporary GPs providing care in a vacant GMP have restricted effectiveness in managing patients compared to the effectiveness achieved by a permanent GP in Hungary, are in concordance with the demonstrated risky nature of the lack of continuity in PHC [22,23,[28][29][30].…”

Section: Observations In International Contextsupporting

confidence: 80%

Association Between the General Practitioner Workforce Crisis and Premature Mortality in Hungary: Nationwide Evaluation of Health Insurance Data from 2006 to 2014

Sándor¹,

Pálinkás²,

Vincze³

et al. 2018

Preprint

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“…However, sensitivity analysis including age variables did not impact on the size of effect of deprivation as an explanatory variable or size of the effect. Although negative binomial regression of counts of deaths would be preferred, 27 the data available meant that this approach was not possible.…”

Section: Discussionmentioning

confidence: 99%

“…Counts of deaths were not available, and it was not possible to use a count model. 27 Primary care trusts and mortality estimates, based on local areas that overlap for some general practices, cannot be considered independent. We adjusted for the clustering effect by using robust SEs.…”

Section: Methodsmentioning

confidence: 99%

Population characteristics, mechanisms of primary care and premature mortality in England: a cross-sectional study

et al. 2016

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ObjectivesHealth systems with strong primary care tend to have better population outcomes, but in many countries demand for care is growing. We sought to identify mechanisms of primary care that influence premature mortality.DesignWe developed a conceptual model of the mechanisms by which primary care influences premature mortality, and undertook a cross-sectional study in which population and primary care variables reflecting the model were used to explain variations in mortality of those aged under 75 years. The premature standardised mortality ratios (SMRs) for each practice, available from the Department of Health, had been calculated from numbers of deaths in the 5 years from 2006 to 2010. A regression model was undertaken with explanatory variables for the year 2009/2010, and repeated to check stability using data for 2008/2009 and 2010/2011.SettingAll general practices in England were eligible for inclusion and, of the total of 8290, complete data were available for 7858.ResultsPopulation variables, particularly deprivation, were the most powerful predictors of premature mortality, but the mechanisms of primary care depicted in our model also affected mortality. The number of GPs/1000 population and detection of hypertension were negatively associated with mortality. In less deprived practices, continuity of care was also negatively associated with mortality.ConclusionsGreater supply of primary care is associated with lower premature mortality even in a health system that has strong primary care (England). Health systems need to sustain the capacity of primary care to deliver effective care, and should assist primary care providers in identifying and meeting the needs of socioeconomically deprived groups.

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“…Recent studies from the United Kingdom also suggest the association between continuity of care and reduced mortality, but they were limited by inconsistent results and the cross-sectional nature of one study. 30,31 We aimed to determine the impact of continuity of care on survival and health care costs in patients with newly diagnosed cardiovascular risk factors, since these represent important, preventable chronic conditions 32,33 to which continuity of care is likely to be highly relevant. 11,15,[34][35][36][37] In South Korea, virtually all Koreans (97%) are covered by National Health Insurance (KNHI), and may consult any primary care physician.…”

Section: Introductionmentioning

confidence: 99%

Impact of Continuity of Care on Mortality and Health Care Costs: A Nationwide Cohort Study in Korea

Shin

Cho

Yang

et al. 2014

The Annals of Family Medicine

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PURPOSE Continuity of care is considered a core element of high-quality primary care, but its impact on mortality and health care costs is unclear. We aimed to determine the impact of continuity of care on mortality, costs, and health outcomes in patients with newly diagnosed cardiovascular risk factors. METHODSWe conducted a cohort study of a 3% nationwide random sample of Korean National Health Insurance enrollees. A total of 47,433 patients who had received new diagnoses of hypertension, diabetes, hypercholesterolemia, or their complications in 2003 or 2004 were included. We determined standard indices of continuity of care-most frequent provider continuity (MFPC), modified, modified continuity index (MMCI), and continuity of care index (COC)-and evaluated their association with study outcomes over 5 years of follow-up. Outcome measures included overall mortality, cardiovascular mortality, incident cardiovascular events, and health care costs. RESULTSThe multivariable-adjusted hazard ratios (HRs) for all-cause mortality, cardiovascular mortality, incident myocardial infarction, and incident ischemic stroke comparing participants with COC index below the median to those above the median were HR = 1.12 (95% CI, 1.04-1.21), 1.30 (1.13-1.50), 1.57 (1.28-1.95), and 1.44 (1.27-1.63), respectively. Similar findings were obtained for other indices of continuity of care. Lower continuity of care was also associated with increased inpatient and outpatient days and costs.CONCLUSIONS Lower indices of continuity of care in patients with newly diagnosed hypertension, diabetes, and hypercholesterolemia were associated with higher all-cause and cardiovascular mortality, cardiovascular events, and health care costs. Health care systems should be designed to support long-term trusting relationships between patients and physicians.

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Modelling factors in primary care quality improvement: a cross-sectional study of premature CHD mortality

Cited by 12 publications

References 25 publications

Association Between the General Practitioner Workforce Crisis and Premature Mortality in Hungary: Nationwide Evaluation of Health Insurance Data from 2006 to 2014

Association Between the General Practitioner Workforce Crisis and Premature Mortality in Hungary: Nationwide Evaluation of Health Insurance Data from 2006 to 2014

Population characteristics, mechanisms of primary care and premature mortality in England: a cross-sectional study

Impact of Continuity of Care on Mortality and Health Care Costs: A Nationwide Cohort Study in Korea

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