Abstract
BackgroundThe number of visits to hospital emergency departments (EDs) in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS). Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England.MethodsA cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services.Main Result and ConclusionGeneral practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001). Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation.
Highlights
The utilisation of emergency departments (EDs) is rising in several high-income countries
The natural logarithm of the general practice population size was used as an offset variable; its coefficient was constrained to unity so that the coefficients of the predictor and control variables could be interpreted in terms of an effect on the number of self-referred discharged ED visits per registered patient, referred to here as the rate of self-referred discharged ED visits
Patients registered to the 7,856 included general practices made 4,537,622 self-referred discharged ED visits in England between April 2010 and March 2011 (Table 1)
Summary
The utilisation of emergency departments (EDs) is rising in several high-income countries. In England’s National Health Service (NHS), the annual number of hospital ED visits increased by 20% between 2007-08 and 2011-12 [1]. The Quality and Outcomes Framework, the U.K.’s primary care pay for performance programme, financially rewards general practices for reviewing patient access and its possible effect on ED utilisation [4]. This effect has not been empirically tested at a national level, and the evidence at a local level is inconclusive [5,6]. The number of visits to hospital emergency departments (EDs) in England has increased by 20% since 200708, placing unsustainable pressure on the National Health Service (NHS). This study examined the association between access to primary care and ED visits in England
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