Access to primary care and visits to emergency departments in England: a cross-sectional, population-based study

PLoS One. 2013 Jun 12;8(6):e66699. doi: 10.1371/journal.pone.0066699. Print 2013.

Abstract

Background: The number of visits to hospital emergency departments (EDs) in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS). Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England.

Methods: A cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services. MAIN RESULT AND CONCLUSION: General practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001). Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cross-Sectional Studies
  • Emergency Service, Hospital / statistics & numerical data*
  • England / epidemiology
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Primary Health Care / statistics & numerical data*
  • Regression Analysis
  • Time Factors

Grants and funding

The Department of Primary Care and Public Health at Imperial College London is grateful for support from the Northwest London National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research & Care (CLAHRC), the Imperial NIHR Biomedical Research Centre (BRC), and the Imperial Centre for Patient Safety and Service Quality (CPSSQ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.