PT - JOURNAL ARTICLE AU - Michael Soljak AU - Amaia Calderon-Larrañaga AU - Pankaj Sharma AU - Elizabeth Cecil AU - Derek Bell AU - Gerrard Abi-Aad AU - Azeem Majeed TI - Does higher quality primary health care reduce stroke admissions? a national cross-sectional study AID - 10.3399/bjgp11X613142 DP - 2011 Dec 01 TA - British Journal of General Practice PG - e801--e807 VI - 61 IP - 593 4099 - http://bjgp.org/content/61/593/e801.short 4100 - http://bjgp.org/content/61/593/e801.full SO - Br J Gen Pract2011 Dec 01; 61 AB - Background Hospital admission rates for stroke are strongly associated with population factors. The supply and quality of primary care services may also affect admission rates, but there is little previous research.Aim To determine if the hospital admission rate for stroke is reduced by effective primary and secondary prevention in primary care.Design and setting National cross-sectional study in an English population (52 763 586 patients registered with 7969 general practices in 152 primary care trusts).Method A combination of data on hospital admissions for 2006–2009, primary healthcare staffing, practice clinical quality and access indicators, census sources, and prevalence estimates was used. The main outcome measure was indirectly standardised hospital admission rates for stroke, for each practice population.Results Mean (3 years) annual stroke admission rates per 100 000 population varied from zero to 476.5 at practice level. In a practice-level multivariable Poisson regression, observed stroke prevalence, deprivation, smoking prevalence, and GPs/100 000 population were all risk factors for hospital admission. Protective healthcare factors included the percentage of stroke or transient ischaemic attack patients whose last measured total cholesterol was ≤5 mmol/l (P<0.001), and ability to book an appointment with a GP (P<0.003). All effect sizes were relatively small.Conclusion Associations of stroke admission rates with deprivation and smoking highlight the need for smoking-cessation services. Of the stroke and hypertension clinical quality indicators examined, only reaching a total cholesterol target was associated with reduced admission rates. Patient experience of access to primary care may also be clinically important. In countries with well-developed primary healthcare systems, the potential to reduce hospital admissions by further improving the clinical quality of primary healthcare may be limited.