RT Journal Article
SR Electronic
T1 Population and patient factors affecting emergency department attendance in London: retrospective cohort analysis of linked primary and secondary care records
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP bjgp18X694397
DO 10.3399/bjgp18X694397
A1 Sally A Hull
A1 Kate Homer
A1 Kambiz Boomla
A1 John Robson
A1 Mark Ashworth
YR 2018
UL http://bjgp.org/content/early/2018/01/15/bjgp18X694397.abstract
AB Background Population factors, including social deprivation and morbidity, predict the use of emergency departments (EDs).Aim To link patient-level primary and secondary care data to determine whether the association between deprivation and ED attendance is explained by multimorbidity and other clinical factors in the GP record.Design and setting Retrospective cohort study based in East London.Method Primary care demographic, consultation, diagnostic, and clinical data were linked with ED attendance data. GP Patient Survey (GPPS) access questions were linked to practices.Results Adjusted multilevel analysis for adults showed a progressive rise in ED attendance with increasing numbers of long-term conditions (LTCs). Comparing two LTCs with no conditions, the odds ratio (OR) is 1.28 (95% confidence interval [CI] = 1.25 to 1.31); comparing four or more conditions with no conditions, the OR is 2.55 (95% CI = 2.44 to 2.66). Increasing annual GP consultations predicted ED attendance: comparing zero with more than two consultations, the OR is 2.44 (95% CI = 2.40 to 2.48). Smoking (OR 1.30, 95% CI = 1.28 to 1.32), being housebound (OR 2.01, 95% CI = 1.86 to 2.18), and age also predicted attendance. Patient-reported access scores from the GPPS were not a significant predictor. For children, younger age, male sex, white ethnicity, and higher GP consultation rates predicted attendance.Conclusion Using patient-level data rather than practice-level data, the authors demonstrate that the burden of multimorbidity is the strongest clinical predictor of ED attendance, which is independently associated with social deprivation. Low use of the GP surgery is associated with low attendance at ED. Unlike other studies, the authors found that adult patient experience of GP access, reported at practice level, did not predict use.