Abstract
BackgroundFrom 2004 to 2009 there was almost a 12% rise in emergency admissions in England. This can be explained partly by an aging population and other socio-demographic characteristics, but much cannot be explained by these factors. We explored aspects of care, in addition to known demographic characteristics in general practice, that are associated with emergency admissions.MethodsA cross-sectional design employing hospital admission data from 76 general practices in Northamptonshire, England for 2006–08, including demographic data, quality and outcomes framework points and GP patient survey outcomes.ResultsThere were statistically significant associations between emergency admissions and age, gender, distance from hospital and proportion classified as white. There was also a statistically significant relationship between emergency admissions and being able to book an appointment with a preferred doctor; this relationship was stronger in less deprived communities.ConclusionsEnabling patients to book with a preferred doctor, particularly those in less deprived communities could have an impact on reducing emergency admissions. It is possible that being able to consult a preferred GP gives patient’s confidence to avoid an emergency admission or it facilitates consistent clinical management that helps prevent the need for admission. However the findings only explained some of the variation.
Highlights
From 2004 to 2009 there was almost a 12% rise in emergency admissions in England
National polices to reduce the trend in emergency admissions have included: accident and emergency fourhour waiting target, payment by results, community matron services, systems to identify patients with an increased risk of admission [5], and more recently financial penalties for readmissions within 30 days [6] and new quality and outcomes framework (QOF) emergency admissions indicators that encourage general practices to review emergency admissions [7]. These approaches on the whole have failed to control the rise in admissions, and recent guidance has suggested that small shifts in the proportion of patients that use primary care, Table 1 Emergency Admissions in England In England, patients may be admitted to hospital as emergencies if, when they fall acutely ill or are injured: 1 they or their carers take them to the emergency department of a hospital; 2 or they are taken to an emergency department by an ambulance; 3 or a general practitioner (GP; including out of-hours services) arranges emergency admission via an emergency department or directly to a hospital ward; 4 or by other routes, for example, through an outpatient department if a patient attends a clinic when seriously ill
index of multiple deprivation 2007 (IMD) scores show that on average Northamptonshire is in the middle quintile of deprivation across England, having practices in 76 practices median
Summary
From 2004 to 2009 there was almost a 12% rise in emergency admissions in England. This can be explained partly by an aging population and other socio-demographic characteristics, but much cannot be explained by these factors. Some of the increase can be explained by an aging population as admission rates have been greater in the over 75 s [3], and as National polices to reduce the trend in emergency admissions have included: accident and emergency fourhour waiting target, payment by results, community matron services, systems to identify patients with an increased risk of admission [5], and more recently financial penalties for readmissions within 30 days [6] and new quality and outcomes framework (QOF) emergency admissions indicators that encourage general practices to review emergency admissions [7] These approaches on the whole have failed to control the rise in admissions, and recent guidance has suggested that small shifts in the proportion of patients that use primary care, In England, patients may be admitted to hospital as emergencies if, when they fall acutely ill or are injured:
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