Imperial College London
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Hilary Watt CStat FHEA MSc MA(Oxon) BA

Faculty of Medicine, School of Public Health

Senior Teaching Fellow in Statistics
 
 
 
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Contact

 

+44 (0)20 7594 7451h.watt Website

 
 
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Location

 

322Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Cowling:2015:10.1136/bmjqs-2015-004338,
author = {Cowling, TE and Harris, M and Watt, H and Soljak, M and Richards, E and Gunning, E and Bottle, A and Macinko, J and Majeed, A},
doi = {10.1136/bmjqs-2015-004338},
journal = {BMJ Quality & Safety},
pages = {432--440},
title = {Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data},
url = {http://dx.doi.org/10.1136/bmjqs-2015-004338},
volume = {25},
year = {2015}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes.Objective To determine whether primary care access is associated with the route of emergency admission—via a GP versus via an A and E department.Methods Retrospective analysis of national administrative data from English hospitals for 2011–2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access—the percentage of patients able to get a general practice appointment on their last attempt—was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics.Results The analysis included 2322112 emergency admissions (81.9% via an A and E department). With a 5unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139673 fewer GP admissions (456232 vs 316559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England.Conclusions Among hospital inpatients admitted as an emergency, patients
AU  - Cowling,TE
AU  - Harris,M
AU  - Watt,H
AU  - Soljak,M
AU  - Richards,E
AU  - Gunning,E
AU  - Bottle,A
AU  - Macinko,J
AU  - Majeed,A
DO  - 10.1136/bmjqs-2015-004338
EP  - 440
PY  - 2015///
SN  - 2044-5415
SP  - 432
TI  - Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data
T2  - BMJ Quality & Safety
UR  - http://dx.doi.org/10.1136/bmjqs-2015-004338
UR  - http://hdl.handle.net/10044/1/25969
VL  - 25
ER  -
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