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

Abstract

BACKGROUND AND OBJECTIVE: Demand for unplanned hospital services is rising, and children are frequent users, especially where access to primary care is poor. In England, universal health care coverage entitles parents to see a general practitioner (GP) for first-contact care. However, access to GP appointments is variable, and few patients can see their own regular GP out of hours (OOH). The goal of this study explored the association between access to GPs , emergency department (ED) visits and short hospitalizations (<2 days) in children in England.METHODS: ED visit and short hospitalization rates were investigated in 9.5 million children aged <15 years registered with English family practices between April 2011 and March 2012 by using administrative hospital data. Six access categories ranked all practices according to patients' reported ability to schedule GP appointments; from national GP Patient Survey data. GP consulting hours were 8:00 AM to 6:30 PM on weekdays.RESULTS: There were 3 074 616 ED visits (56% OOH) and 470 752 short hospitalizations over the 12 months studied. Children registered with practices in the highest access group compared with the lowest were 9% less likely to visit an ED (adjusted rate ratio: 0.91 [95% confidence interval: 0.89-93]), particularly OOH compared with consulting hours (10% vs 7%). Children in the highest access groups were equally likely to be admitted for a short stay. CONCLUSIONS:Increasing GP accessibility might alleviate the burden of ED visits from children, particularly during peak times OOH. Short hospitalizations may be more sensitive to other aspects of health systems.

Assessment of access to primary health care among children and adolescents hospitalized due to avoidable conditions

“…However, an undesirable impact was noted: a reduction in scheduled appointments and impairment of longterm medical monitoring, 29 as well as a high and often unnecessary demand for emergency room services and hospitalizations. 12 In the present study, it was found that other aspects, besides the organization of services, have an impact on access and use of the services. The way of thinking and acting when faced with health needs may have contributed to the low scores found.…”

“…7 In the United Kingdom, despite the PHC system being well structured, it was noted that access barriers are associated with the high prevalence of demand for emergency services and unnecessary hospitalizations. 12 Studies about the factors that may be associated with avoidable hospitalizations are rarer in Brazil and are generally limited to describing the variables that were most linked to the risk of hospitalization for these conditions. 13 The studies seeking to understand access to and quality of the care provided to patients for these causes are rare, despite this type of evaluation being considered fundamental to define public health policies.…”

Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis

“…Past research shows that patients with an urgent healthcare problem are unwilling to wait more than 1 day for an appointment with their own physician 69. Demand for unplanned services is rising and this has been shown to rise further when access to PCP care is reduced 70. A systematic review of primary care factors that impact on unscheduled secondary care use showed that better primary care access led to reduced unscheduled care,71 with increased access to primary care leading to a reduction in ED attendances.…”

Risk of ketoacidosis in children at the time of diabetes mellitus diagnosis by primary caregiver status: a population-based retrospective cohort study

“…Similar to our findings, studies in the general pediatrics literature have shown an association between having a usual provider of care and decreased use of acute health services (i.e., hospital admissions, emergency department visits). 12,29,30 Several mechanisms may explain the relation between having a usual provider of care and presence of DKA at diabetes onset. These include the beneficial effects of continuous primary care, whereby the provider has background knowledge of a child's baseline health status and would be more alert to new symptoms; the beneficial effects of preventive care, whereby parents are counselled during well-child care visits about general health and are told whom to contact in case of illness; and the beneficial effects of the underlying physician-patient relationship, which may influence families' health-seeking behaviours, with parents being more willing to seek medical help from their usual provider of care for nonemergent issues.…”