Socioeconomic deprivation and accident and emergency attendances: cross-sectional analysis of general practices in England

Scantlebury, Rachel; Rowlands, Gillian; Durbaba, Stevo; Schofield, Peter; Sidhu, Kalwant; Ashworth, Mark

doi:10.3399/bjgp15x686893

Cited by 34 publications

(51 citation statements)

References 26 publications

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“…Candidacy, defined as “the ways in which people's eligibility for medical attention and intervention is jointly negotiated between individuals and health services,” was the umbrella concept for two CMO configurations: “assumptions” and “surveillance.” The concept suggests that a woman's “candidacy” for maternity services is materially, culturally, and organizationally constructed. For example, it is well known that more deprived women access preventative health care services less than more affluent women, and have higher use of emergency services . Candidacy is thought to be at play here, with factors such as help‐seeking in response to crisis symptoms rather than to prevent poor health, the normalization and acceptance of poor health, and fear of blame from health care professionals apparent across many of the included studies.…”

Section: Discussionmentioning

confidence: 99%

How do women with social risk factors experience United Kingdom maternity care? A realist synthesis

Rayment-Jones

Harris

Harden

et al. 2019

Birth

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Background Echoing international trends, the most recent United Kingdom reports of infant and maternal mortality found that pregnancies to women with social risk factors are over 50% more likely to end in stillbirth or neonatal death and carry an increased risk of premature birth and maternal death. The aim of this realist synthesis was to uncover the mechanisms that affect women's experiences of maternity care. Methods Using realist methodology, 22 papers exploring how women with a wide range of social risk factors experience maternity care in the United Kingdom were included. The data extraction process identified contexts (C), mechanisms (M), and outcomes (0). Results Three themes, Resources, Relationships, and Candidacy, overarched eight CMO configurations. Access to services, appropriate education, interpreters, practical support, and continuity of care were particularly relevant for women who are unfamiliar with the United Kingdom system and those living chaotic lives. For women with experience of trauma, or those who lack a sense of control, a trusting relationship with a health care professional was key to regaining trust. Many women who have social care involvement during their pregnancy perceive health care services as a system of surveillance rather than support, impacting on their engagement. This, as well as experiences of paternalistic care and discrimination, could be mitigated through the ability to develop trusting relationships. Conclusions The findings provide underlying theory and practical guidance on how to develop safe services that aim to reduce inequalities in women's experiences and birth outcomes.

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Section: Discussionmentioning

confidence: 99%

How do women with social risk factors experience United Kingdom maternity care? A realist synthesis

Rayment-Jones

Harris

Harden

et al. 2019

Birth

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“…Tammes et al 33 examined data from 2012 to 2013 and reported similar findings for the above outcome variable and also for an outcome including additional types of A&E department. Scantlebury et al 34 investigated all A&E visits in 2011–2012 and reported that practices where patients were more likely to be able to get an appointment had lower A&E visit rates. Cecil et al 22 also found this association in 2011–2012 for children aged less than 15 years old 22.…”

Section: Discussionmentioning

confidence: 99%

Patient experience of general practice and use of emergency hospital services in England: regression analysis of national cross-sectional time series data

2018

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“…This decreasing trend in emergency presentations overall has occurred in spite of other evidence for opposite, (increasing) trends in both general A&E attendance and emergency hospital admissions. [22][23][24][25][26][27] Therefore, the overall trend cannot be accounted for by such general A&E/ emergency admission trends, and likely reflects a reciprocal rise in the use by GPs of 2WW referrals for suspected cancer in the same period (Figure 1). 28 Among emergency presenters, reductions in the GP-EP sub-route could reflect increasing difficulties in accessing in-hours primary care among patients with possible cancer symptoms; 26,29,30 and the progressive shrinkage (through the overall increase in 2WW referrals) of the pool of patients who would have otherwise been diagnosed with cancer as an emergency presentation.…”

Section: Implications For Research and Practicementioning

confidence: 99%

Cancer diagnoses after emergency GP referral or A&E attendance in England: determinants and time trends in Routes to Diagnosis data, 2006–2015

et al. 2019

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BackgroundDiagnosis of cancer as an emergency is associated with poor outcomes but has a complex aetiology. Examining determinants and time trends in diagnostic routes can help to appreciate the critical role of general practice over time in diagnostic pathways for patients with cancer.AimTo examine sociodemographic, cancer site, and temporal associations with type of presentation among patients with cancer diagnosed as emergencies.Design and settingAnalysis of Routes to Diagnosis data, 2006–2015, for patients with cancer in England.MethodThe authors estimated adjusted proportions of emergency presentation after emergency GP referral (GP-EP) or presentation to accident and emergency (AE-EP), by patient sex, age, deprivation group, and year of diagnosis using multivariable regression.ResultsAmong 554 621 patients presenting as emergencies, 24% (n = 130 372) presented as GP-EP, 62% as AE-EP (n = 346 192), and 14% (n = 78 057) through Other-EP sub-routes. Patients presenting as emergencies were more likely to have been GP-referred if they lived in less deprived areas or were subsequently diagnosed with pancreatic, gallbladder, or ovarian cancer, or acute leukaemia. During the study period the proportion and number of GP-EPs nearly halved (31%, n = 17 364, in 2006; 17%, n = 9155 in 2015), while that of AE-EP increased (55%, n = 31 049 to 68%, n = 36 868).ConclusionPatients presenting as emergencies with cancers characterised by symptoms/signs tolerable by patients but appropriately alarming to doctors (for example, pancreatic cancer manifesting as painless jaundice) are over-represented among cases whose emergency presentation involved GP referral. Reductions in diagnoses of cancer through an emergency presentation likely reflect both the continually increasing use of 2-week-wait GP referrals during the study period and reductions in emergency GP referrals.

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Socioeconomic deprivation and accident and emergency attendances: cross-sectional analysis of general practices in England

Cited by 34 publications

References 26 publications

How do women with social risk factors experience United Kingdom maternity care? A realist synthesis

How do women with social risk factors experience United Kingdom maternity care? A realist synthesis

Patient experience of general practice and use of emergency hospital services in England: regression analysis of national cross-sectional time series data

Cancer diagnoses after emergency GP referral or A&E attendance in England: determinants and time trends in Routes to Diagnosis data, 2006–2015

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