Variation in general practice medical admission rates for elderly people

Abstract

Admission rates show considerable variation between practices, which is only partly explained by morbidity rates, and consistency over 3 years.

Recurring Outbreaks of an Infection Apparently Targeting Immune Function, and Consequent Unprecedented Growth in Medical Admission and Costs in the United Kingdom: A Review

“…All of the supposedly causative factors such as, supply-induced demand, an ageing population, the elderly living alone, conservative GP and hospital consultant behavior, health care consumerism, rapid advances in technology and increasing complexity of treatable conditions, the failure of health care organizations to 'manage' demand, inappropriate admissions, lack of integration between health and social care [5][6][7][8][9][10][11][12][13][14][15][16][17][18], have never been proven to be causative in that all show roughly steady growth over time and cannot explain the step-like increases in death and medical admissions which sweep across the UK and Europe (see Section 6).…”

“…Rising medical admissions have been observed since the 1980's and even earlier. There was a 45% increase in Scotland between 1981 and 1994 [1], an 85% increase in Bournemouth between 1992 and 2001 (25% between 1997 and 2001) [2], an 80% increase in admissions via the emergency department in Sheffield between 1988 and 1995 [3], and a 45% (Hull), 65% (Scarborough) and 75% (Sheffield) increase respectively in admissions via the emergency departments between 1987 and 1997 in the north of England, where the proportion admitted rose from around 9% to 17% in the same period [4], and an 86% rise in age 75+ admissions between 1990 and 2000 in Gloucester during a time when the age 75+ population only grew by 24% [5]. Fig.…”

“…Up to the present, the rapid growth in acute demand has been explained by factors such as supply-induced demand, an ageing population, the elderly living alone, conservative GP and hospital consultant behavior, health care consumerism, rapid advances in technology and increasing complexity of treatable conditions, the failure of health care organizations to 'manage' demand, lack of integration between health and social care and ease of access to primary care [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Whilst not denying that such factors have a role, generally speaking, to require acute care a person has to be genuinely ill or via an outpatient consultation have a condition requiring specialist diagnosis.…”

Association of population and practice factors with potentially avoidable admission rates for chronic diseases in London: cross sectional analysis

“…Previous UK studies suggested that many practices are starting from very different baselines with deprivation, poor health and underdeveloped care accounting for variation in admission rates to hospital. [17][18][19]20 We aimed to test the hypothesis that higher levels of underlying ill health in the population, material deprivation and lower levels of primary care service provision are each associated with increased rates of potentially avoidable hospital admissions in primary care trusts in London. We selected London for study because it has an ethnically and socio-economically diverse population.…”

Contemporary referral of patients from community care to cardiology lack diagnostic and clinical detail

“…This study is centred on the process of referral from general practitioners that underlines patient flow in the NHS. Volume patterns are demonstrably highly variable with both thresholds and consistency differing between practices and the perceptions of each sector of its capacity to correctly define illness (8,9). Reasons for referral are complex (10,11).…”