How sensitive are avoidable emergency department attendances to primary care quality? Retrospective observational study

Beth Parkinson,Kath Checkland,Matt Sutton,Rachel Meacock

doi:10.1136/bmjqs-2020-011651

Abstract

BackgroundImprovements in primary care quality are often proposed as a solution to rises in emergency department (ED) attendances. However, there is little agreement on what constitutes an avoidable attendance, and...

Highlights

Increases in the volume of emergency department (ED) attendances have put pressure on healthcare services worldwide, resulting in adverse impacts on the quality and safety of patient care.[1]
Distance to the nearest ED, the response rate to the General Practitioner Patient Survey (GPPS) and the rate of attendance at other emergency care facilities are negatively associated with ED attendances across all four measures
Improvements in primary care quality are often proposed as a solution to the problem of continually increasing ED attendances

Summary

Introduction

To replicate the findings from their systematic review, Tammes and colleagues conducted both cross- sectional[5] and longitudinal studies[6] using data from across England Both studies showed some evidence of an association between accessibility of primary care and the volume of attendances that were self-referred and did not result in an admission. Another recent study in England found no association between patient experience of general practice and the volume of ED attendances.[7]. We linked practice-level counts of attendances to seven measures of primary care access, patient experience and clinical quality for 7521 practices. Attendances are much less responsive to differences in primary care quality than indicated by estimates of the prevalence of avoidable attendances. This may explain the failure of initiatives to reduce attendances through primary care improvements

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Conclusion