Primary care access and its relationship with emergency department utilisation: an observational, cross-sectional, ecological study

Abstract

BackgroundRecent health service policies in the UK have focused on improving primary care access in order to reduce the use of costly emergency department services, even though the relationship between the two is based on weak or little evidence. Research is required to establish whether improving primary care access can influence emergency department attendance. AimTo ascertain whether a relationship exists between the degree of access to GP practices and avoidable emergency department attendances in an inner-London primary care trust (PCT). Design and settingObservational, cross-sectional ecological study in 68 general practices in Brent Primary Care Trust, north London, UK. MethodGP practices were used as the unit of analysis and avoidable emergency department attendance as the dependent variable. Routinely collected data from GP practices, Hospital Episode Statistics, and census data for the period covering 2007-2009 were used across three broad domains: GP access characteristics, population characteristics, and health status aggregated to the level of the GP practice. Multiple linear regression was used to ascertain which variables account for the variation in emergency department attendance experienced by patients registered to each GP practice. ResultsNone of the GP access variables accounted for the variation in emergency department attendance. The only variable that explained this variance was the Index of Multiple Deprivation (IMD). For every unit increase in IMD score of the GP practice, there would be an increase of 6.13 (95% CI = 4.56, 7.70) per 1000 patients per year in emergency department attendances. This accounted for 47.9% of the variance in emergency department attendances in Brent. ConclusionAvoidable emergency department attendance appears to be mostly driven by underlying deprivation rather than by the degree of access to primary care.

Explaining variation in emergency admissions: a mixed-methods study of emergency and urgent care systems

“…It is also worth noting that the relationship between poor perceived access to general practice and high use of EDs has not always been found. 56 This is also true for its relationship with emergency admissions. 20 …”

Does the extension of primary care practice opening hours reduce the use of emergency services?

“…Harris et al (2011) conduct a cross-sectional ecological study of one Primary Care Group, whereby they test whether ED attendance can be explained by varying accessibility to GP practices proxied by total opening hours per week. None of the proxies for accessibility turns out significant, thus suggesting that the use of the ED is probably driven by the underlying characteristics of users, including that of social deprivation.…”

Factors associated with choosing the emergency department as the primary access point to health care: a Canadian population cross-sectional study

“…17 Our results agree with numerous other studies reporting low socioeconomic status contributing to an increased use of the ED. 3,9,10,14,17,18 However, what our study adds is that it also leads to a decrease in use of ED alternatives.…”

“…[7][8][9][10] Evidence suggests that ED overcrowding is associated with adverse clinical outcomes, [10][11][12] and proposed solutions have ranged from streamlining inpatient admissions to expanding primary care. [13][14][15] It is important to understand the current patterns of ED use if primary health care initiatives are to effectively reduce ED workloads and improve overall health. Jones et al in a before/after study found that an after-hours urgent care clinic reduced the number of those seeking care in the ED.…”