Abstract
BackgroundThe UK National Health Service Emergency Departments (ED) have recently faced increasing attendance rates. This study investigated associations of general practice and practice population characteristics with emergency care service attendance rates.MethodsA longitudinal design with practice-level measures of access and continuity of care, patient population demographics and use of emergency care for the financial years 2009/10 to 2012/13. The main outcome measures were self-referred discharged ED attendance rate, and combined self-referred discharged ED, self-referred Walk-in Centre (WiC) and self-referred Minor Injuries Unit (MIU) attendance rate per 1000 patients. Multilevel models estimated adjusted regression coefficients for relationships between patients’ emergency attendance rates and patients’ reported satisfaction with opening hours and waiting time at the practice, proportion of patients having a preferred GP, and use of WiC and MIU, both between practices, and within practices over time.ResultsPractice characteristics associated with higher ED attendance rates included lower percentage of patients satisfied with waiting time (0.22 per 1% decrease, 95%CI 0.02 to 0.43) and lower percentage having a preferred GP (0.12 per 1% decrease, 95%CI 0.02 to 0.21). Population influences on higher attendance included more elderly, more female and more unemployed patients, and lower male life-expectancy and urban conurbation location. Net reductions in ED attendance were only seen for practices whose WiC or MIU attendance was high, above the 60th centile for MIU and above the 75th centile for WiC. Combined emergency care attendance fell over time if more patients within a practice were satisfied with opening hours (−0.26 per 1% increase, 95%CI −0.45 to −0.08).ConclusionPractices with more patients satisfied with waiting time, having a preferred GP, and using MIU and WIC services, had lower ED attendance. Increases over time in attendance at MIUs, and patient satisfaction with opening hours was associated with reductions in service use.
Highlights
The UK National Health Service Emergency Departments (ED) have recently faced increasing attendance rates
The results show that differences between general practices in their patients’ attendance rates at urgent care services including ED, Minor Injuries Unit (MIU) and WIC between 2009/10 and 2012/13 are related to elements of general practice provision as well as socio-demographic characteristics of the practice population and geographical factors
Combined emergency care attendance fell over time if more patients within a general practice were satisfied with the practice opening hours
Summary
The UK National Health Service Emergency Departments (ED) have recently faced increasing attendance rates. This study investigated associations of general practice and practice population characteristics with emergency care service attendance rates. The increase in the number of attendees at EDs in England over recent years has resulted in considerable pressure on these services, and is a major concern for National Health Service (NHS) sustainability. We have followed up on these findings, by investigating associations between general practice-related factors and ED attendance over time in order to highlight potential measures to reduce the pressure on ED. A recent systematic review identified general practice factors which affect ED attendance [5]. A more recent cross-sectional study partially replicated the findings from this systematic review but importantly included previously untested factors in a contemporary England wide context [6]. General practices located in urban conurbation areas showed higher ED attendance rates
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