Risk taking in general practice: GP out-of-hours referrals to hospital

Ingram, Jenny; Calnan, Michael; Greenwood, Rosemary; Kemple, Terry; Payne, Sarah; Rossdale, Michael

doi:10.3399/bjgp09x394824

Cited by 33 publications

(32 citation statements)

References 5 publications

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“…This finding may be a further evidence of the positive impact of initiatives within Blackpool primary care. Variations in GP referral practices [1,27] and quality of primary care [22] have been suggested by some as explanations for variations in emergency admissions.…”

Section: Discussion the Findings In Relation To Other Studiesmentioning

confidence: 99%

Determinants of Emergency Hospital Admissions among Patients in Blackpool, England: Population-Based Cross-Sectional Study

Agboado¹,

Mills²

2011

J Clinic Res Bioeth

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Objectives: To examine the relative importance of patients' socio-demographic characteristics, health service factors, health conditions, day and season of admission as predictors of emergency admissions among Blackpool residents.Study design: Population-based cross-sectional study using routine patient admission data. Records of admissions among Blackpool patients were analysed to examine the effects of socio-demographic factors, health service factors, health conditions, day and season of admissions on emergency admissions. Principal results:The emergency admission risk has declined over the study period. Compared with admissions in people aged 35 to 44, admissions in those aged 85 and above were 3.2 times more likely to be emergencies. Admissions from 4th IMD quintile areas were 43% more likely to be emergencies compared with those from 2nd IMD quintile areas. Admissions among patients registered with Blackpool GPs were less likely to be emergencies compared with those registered with GPs outside Blackpool. Admissions to geriatric medical specialties were most likely to be emergencies. Emergency admission risk was highest for admissions attributed to accidents. Emergency admission risk was also highest for Saturday admissions and lowest for Wednesday admissions. No significant association was observed between emergency admissions and patients' sex. Conclusions:The risk of emergency admissions among Blackpool patients has declined over the period of this study. Socio-demographic and health service factors, health conditions, day and season of admission were independently associated with emergency admissions. [12]. A provider spell is the time that a patient stays with one hospital care provider from admission to discharge, transfer or death [13]. Records of admission spells for Blackpool patients over the period were extracted for analyses.Emergency admissions are admissions that are unpredictable and at short notice because of clinical needs [12]. Admissions classified as emergencies in this study were those coded as 21, 22, 23, 24 and 28 [12]. Primary diagnoses at admission were classified according to the World Health Organization's ICD-10 (International Classification of Disease, 10 th revision).[14] Specialty classifications used broadly followed those contained in the dataset [12] (see Appendix 1 for details). We used the ONS classification of the seasons used in the excess winter deaths calculations [15]. GP practices were coded A to V to eliminate the risk of identifying patients because of the relatively small practice list sizes.Postcodes of patients' places of residence were linked to their respective 2007 Indices of Multiple Deprivation (IMD) [16] which are composite scores derived from seven deprivation domains. The scores were further grouped into their corresponding national score quintiles -the higher the quintile the more deprived an area is. The resultant dataset was analysed to describe emergency admission patterns and identify factors associated with emergency admission. Statistica...

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Section: Discussion the Findings In Relation To Other Studiesmentioning

confidence: 99%

Determinants of Emergency Hospital Admissions among Patients in Blackpool, England: Population-Based Cross-Sectional Study

Agboado¹,

Mills²

2011

J Clinic Res Bioeth

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“…Primary care practitioners are also important actors in the interplay between patients and healthcare outcomes -and, while standardization of practice by protocols is commonplace -the variations in acceptance of risk between practitioners is highly likely to alter the likelihood of referral to secondary care for a given PCSC presentation to primary care. 22 While healthcare practitioners in primary care have the potential to fulfil their duties of providing coordinated, comprehensive care close to home, it is essential that they be provided with the necessary resources to do so. For primary care -and the healthcare professionals who work within it -to effectively and efficiently manage an increasing burden of chronic disease, it must be provided with the necessary infrastructure and resources to enable delivery of care.…”

Section: Primary Care Sensitive Conditions and Policy Responsementioning

confidence: 99%

Defining primary care sensitive conditions: a necessity for effective primary care delivery?

et al. 2012

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SummaryPrimary care is a major component of England's National Health Service (NHS), responsible for approximately 300 million consultations per year with GPs in England, which represents 70 -90% of all patient contacts with the NHS. In addition to providing healthcare to the registered population, GPs are charged with coordination and gatekeeping of access to services provided by secondary care, tertiary care and other allied healthcare providers. As GPs will be assuming a key role in commissioning health services in England, there is a clear opportunity to re-model care delivery to maximize outcomes, cost efficiency and patient access by focusing on diseases that are most amenable to management in primary care. It is essential that there is evidence to inform what conditions are most sensitive to management in primary care -commonly referred to as primary care sensitive conditions or ambulatory care sensitive conditions. Such definitions would aid resource planning, drafting of local management protocols and simplification of the interface between primary and secondary care for a number of chronic conditions. Indeed, inappropriate utilization of secondary care resources is likely to represent a significant opportunity cost to healthcare providers and may be less desirable for patients.Primary care is a major component of England's National Health Service (NHS), responsible for approximately 300 million consultations per year with general practitioners (GPs) in England, 1 which represents 70-90% of all patient contacts with the NHS.2 In addition to providing healthcare to the registered population, GPs are charged with coordination and gatekeeping of access to services provided by secondary care, tertiary care and other allied healthcare providers.While primary care has a role to play in the management of acute conditions, there are a number of alternative means by which individuals can directly access appropriate advice and care for acute problems via services such as NHS Direct, Walk-in Centres and Accident & Emergency Departments. In contrast, the management of chronic conditions generally lies within the remit of GPs, and patients are usually only able to obtain ongoing specialist care for their condition if referred to a specialist by their GP.Primary care consultation rates in England are rising year-on-year, 1 and the role of primary careThis is the second article in a series on health policy DECLARATIONS Competing interestsNone declared

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“…Each study has provided, in different ways, key insights into the effects of different contraceptives; as well as novel information about other women's health issues. For example, the RCGP study was the first to show that the risk of cardiovascular disease is much higher in pill users who smoke, 5 especially among older women, and that the risk of hypertension and arterial disease is related to the combined pill's progestogen…”

Section: Address For Correspondencementioning

confidence: 99%

“…A recent study investigating male GPs' attitudes to rural general practice in New Zealand suggests that, while the challenge and variety of on-call work may appeal to younger GPs, older GPs, despite being more experienced, describe increasing resentment about the continued need to undertake stressful oncall work. 4 As Ingram et al describe in their paper in this issue, 5 GPs vary considerably in their attitude to risk taking, and this affects OOH referral rates. Variability in risk aversion is also likely to affect GPs' willingness, or otherwise, to tolerate the increased clinical and/or personal risk inherent in OOH work.…”

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confidence: 99%