Imperial College London
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ProfessorPaulAylin

Faculty of Medicine, School of Public Health

Professor of Epidemiology and Public Health
 
 
 
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Contact

 

p.aylin Website

 
 
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Location

 

Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Cecil:2021:10.3399/BJGP.2020.0986,
author = {Cecil, E and Bottle, A and Majeed, A and Aylin, P},
doi = {10.3399/BJGP.2020.0986},
journal = {British Journal of General Practice},
pages = {e547--e554},
title = {Factors associated with potentially missed acute deterioration in primary care},
url = {http://dx.doi.org/10.3399/BJGP.2020.0986},
volume = {24/6/21},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BACKGROUND: In the UK, the majority of primary care contacts are uncomplicated. However, safety incidents resulting in patient harm occur, such as failure to recognise a patient's deterioration in health. AIM: We aimed to determine patient and healthcare factors associated with potentially missed deterioration. DESIGN AND SETTING: A cohort of patients registered with English CPRD general practices between 01-04-2014 and 31-12-2017 with linked hospital data. METHODS: We defined a potentially missed deterioration as a patient, seen in primary care by a GP in the three days before hospitalisation, having a self-referred admission. We used generalised estimating equations to investigate factors associated with odds of a self-referred admission. We investigated all diagnoses and subsets of commonly reported missed conditions. RESULTS: There were 116,097 patients who contacted a GP three days prior to an emergency admission. Patients with sepsis or urinary tract infections were more likely to self-refer, adjusted odds ratio 1.10 95%CI(1.02-1.19) and 1.09 (1.04-1.14) respectively. GP appointment durations were associated with self-referral. On average, a 5-minute increase resulted in 10% decrease in odds of self-referred admissions, 0.90 (0.89-0.91). Patients having a telephone (compared with face-to-face) consultation 1.13 (1.09-1.16), previous health service use and health status were also associated with self-referred admission. CONCLUSIONS: Differentiating deterioration from self-limiting conditions can be difficult for clinicians, particularly in patients with sepsis, UTI or with long-term conditions. Our findings supports the call for longer GP consultations and cautions reliance on telephone consultations in primary care; however, research is needed to understand the underlying mechanisms.
AU  - Cecil,E
AU  - Bottle,A
AU  - Majeed,A
AU  - Aylin,P
DO  - 10.3399/BJGP.2020.0986
EP  - 554
PY  - 2021///
SN  - 0960-1643
SP  - 547
TI  - Factors associated with potentially missed acute deterioration in primary care
T2  - British Journal of General Practice
UR  - http://dx.doi.org/10.3399/BJGP.2020.0986
UR  - https://www.ncbi.nlm.nih.gov/pubmed/33657010
UR  - https://bjgp.org/content/71/708/e547/
UR  - http://hdl.handle.net/10044/1/87161
VL  - 24/6/21
ER  -
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