Emergency hospital admissions for asthma and access to primary care: cross-sectional analysis

Abstract

Background: Access to general practices may be an important determinant of emergency admissions for asthma, as early treatment of exacerbations has been shown to prevent deterioration. Aim: To determine whether access to primary care is associated with emergency admissions for asthma. Design and Setting: Cross-sectional analysis of data from English practices in 2010/11. Method: Negative binomial regression was used to explore the associations between emergency admissions for asthma and seven measures of patient-reported access to general practice services taken from GP Patient Survey, controlled for the characteristics of practice populations. Incidence rate ratios (IRR) were calculated for each association. Results: 7806 (95%) of practices had data for all variables. There were 3,134,106 patients with asthma, and there were 55,570 emergency admissions with asthma. Admission rates were lower in practices with a higher composite access score (adjusted IRR for 10% change in variable 0.679 (95%CI 0.665 to 0.708)). Admissions were higher in those practices with higher proportions of the practice population who were white, and in practices with lower performance in the Quality and Outcomes Framework indicator ‘asthma review in past 15 months’ (Asthma 6). Assuming these associations were causal, a higher access score of 10% was associated with a decrease of 17,837 admissions per year for these practices. Conclusion: Practices with higher patient reported access had lower rates of emergency admissions for asthma. Policy makers should consider improving access to primary care as one potential way to help prevent emergency hospital admissions for asthma

Associations between structures and resources of primary care at the district level and health outcomes: a case study of diabetes mellitus care in Thailand

“…Such associations have been consistently observed, for example, in a previous study that reported that improving timely access to primary care for early treatment of exacerbations resulted in a lower rate of emergency admissions for asthma. 23 …”

Patient experience of general practice and use of emergency hospital services in England: regression analysis of national cross-sectional time series data

“…These studies focused on specific conditions such as asthma,31 chronic obstructive pulmonary disease25 and heart failure 26. Practices with higher scores on GPPS measures related to access had lower adjusted admission rates in all but one study, though the exact measure(s) showing this association is inconsistent across studies.…”

Asthma admission rates and patterns of salbutamol and inhaled corticosteroid prescribing in England from 2013 to 2017

“…We did not observe significant relationships between asthma QOF scores and admission rates, suggesting that annual reviews alone may not be sufficient to reduce admissions. Purdy et al also found no association between QOF scores and admissions,2 while Fleetcroft et al found that improved access to General Practice was associated with reduced asthma admissions 10. Better primary care management of asthma is likely to reduce admissions, but QOF metrics may not capture the key drivers of this improvement.…”