Abstract
BackgroundDelivering good quality primary care for patients with chronic conditions has the potential to reduce non-elective hospital admissions. Practice nurse staffing levels in England have been linked to attainment of general practice performance targets for some chronic conditions. The aim of this study was to examine whether practice nurse staffing level is similarly associated with non-elective hospital admissions in three clinical areas: asthma, Chronic Obstructive Pulmonary Disease (COPD) and diabetes.MethodsThis observational study used cross sectional analysis of routinely collected data. Hospital admissions data for the period 2005-2006 (for asthma, COPD and diabetes) were linked with a database of practice characteristics, nurse staffing data and data on population characteristics for the same period. Statistical modelling explored the relationship between non-elective hospital admission rates for the three conditions and the list size per full time equivalent (FTE) practice nurse.ResultsHigher practice nurse staffing levels were significantly associated with lower rates of admission for asthma (p < 0.001) and COPD (p < 0.001). A similar association was seen for patients with two or more admissions (p < 0.05 for asthma and p < 0.001 for COPD). For diabetes, higher practice nurse staffing level was significantly associated with higher admission rates (p < 0.05), but this association was not significant in case of patients with two or more admissions. Across all models, increasing deprivation was associated with higher admission rates for all conditions.ConclusionsThe inconsistent relationship between nurse staffing and patient outcomes across the different conditions and the fact that for diabetes the relationship between staffing and outcomes was in a different direction from the association between staffing and care quality, highlights the need to avoid making a simple causal interpretation of these findings and reduces the possible confidence in such conclusions. There is a need for more research into the organisation and delivery of diabetes care services in general practice, preferably using patient level data; in order to better understand the impact of the different staffing configurations on patient outcomes.
Highlights
Delivering good quality primary care for patients with chronic conditions has the potential to reduce non-elective hospital admissions
The association was positive and showed significance in two of the three models fitted. This suggests that higher nurse staffing levels have been shown to be associated with better compliance with processes of care and better intermediate clinical outcomes resulting in achieving higher Quality and Outcomes Framework (QOF) scores [1], its association with non-elective hospital admissions is likely to be dependent on other factors including the specific disease, service configurations and patient related factors not included in our models
The association between practice nurse staffing levels and non-elective admission rates was variable across the three clinical areas studied, namely asthma, Chronic Obstructive Pulmonary Disease (COPD) and diabetes
Summary
Delivering good quality primary care for patients with chronic conditions has the potential to reduce non-elective hospital admissions. The aim of this study was to examine whether practice nurse staffing level is associated with non-elective hospital admissions in three clinical areas: asthma, Chronic Obstructive Pulmonary Disease (COPD) and diabetes. In this study we Hospital admissions for complications of chronic conditions, such as asthma and diabetes, have been steadily increasing [2]. This represents a huge burden on healthcare systems. Delivering better quality primary care for patients with chronic conditions might lead to fewer hospital admissions. Non-elective admission rates can be a useful proxy measure (a valid indicator) of primary care quality
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