Characteristics of general practices associated with emergency-department attendance rates: a cross-sectional study
- 16 June 2011
- journal article
- research article
- Published by BMJ in BMJ Quality & Safety
- Vol. 20 (11), 953-958
- https://doi.org/10.1136/bmjqs.2010.050864
Abstract
Background Strategies are needed to contain emergency-department attendance. Quality of care in general practice might influence the use of emergency departments, including management of patients with chronic conditions and access to consultations. Aim The aim was to determine whether emergency‐department attendance rates are lower for practices with higher quality and outcomes framework performance and lower for practices with better patient reported access. Design A cross-sectional study. Setting Two English primary-care trusts, Leicester City and Leicestershire County and Rutland, with 145 general practices. Method Using data on attendances at emergency departments in 2006/2007 and 2007/2008, a practice attendance rate was calculated for each practice. In a hierarchical negative binomial regression model, practice population characteristics (deprivation, proportion of patients aged 65 or over, ethnicity, gender) and practice characteristics (total list size, distance from the emergency department, quality and outcomes framework points, and variables measuring satisfaction with access) were included as potential explanatory variables. Results In both years, greater deprivation, shorter distance from the central emergency department, lower practice list size, white ethnicity and lower satisfaction with practice telephone access were associated with higher emergency-department attendance rates. Conclusions Performance as indicated by the quality and outcomes framework did not predict rates of attendance at emergency departments, but satisfaction with telephone access did. Consideration should be given to improving access to some general practices to contain the use of emergency departments.Keywords
This publication has 17 references indexed in Scilit:
- Characteristics of general practices associated with emergency admission rates to hospital: a cross-sectional studyEmergency Medicine Journal, 2011
- How have changes to out-of-hours primary care services since 2004 affected emergency department attendances at a UK District General Hospital? A longitudinal studyEmergency Medicine Journal, 2009
- Reliability of patient responses in pay for performance schemes: analysis of national General Practitioner Patient Survey data in EnglandBMJ, 2009
- Is referral to emergency care practitioners by general practitioners in-hours effective?Emergency Medicine Journal, 2009
- Distances to Emergency Department and to Primary Care Provider’s Office Affect Emergency Department Use in ChildrenAcademic Emergency Medicine, 2009
- Expanding the Definition of Access: It Isn't Just About Health InsuranceJournal of Health Care for the Poor and Underserved, 2008
- The impact of co-located NHS walk-in centres on emergency departmentsEmergency Medicine Journal, 2007
- Does better access to primary care reduce utilization of hospital accident and emergency departments? A time-series analysisEuropean Journal of Public Health, 2006
- Urban legend versus rural reality: patients' experience of attendance at accident and emergency departments in west WalesEmergency Medicine Journal, 2005
- A paradigm shift in the nature of care provision in emergency departmentsEmergency Medicine Journal, 2004