Elizabeth Cecil1, Alex Bottle2, Thomas E Cowling2, Azeem Majeed2, Ingrid Wolfe3, Sonia Saxena2. 1. Department of Primary Care and Public Health, Imperial College London, London, United Kingdom; and e.cecil@imperial.ac.uk. 2. Department of Primary Care and Public Health, Imperial College London, London, United Kingdom; and. 3. Department of Primary Care and Public Health Sciences, King's College London, London, United Kingdom.
Abstract
BACKGROUND AND OBJECTIVE: Demand for unplanned hospital services is rising, and children are frequent users, especially where access to primary care is poor. In England, universal health care coverage entitles parents to see a general practitioner (GP) for first-contact care. However, access to GP appointments is variable, and few patients can see their own regular GP out of hours (OOH). The goal of this study explored the association between access to GPs , emergency department (ED) visits and short hospitalizations (<2 days) in children in England. METHODS: ED visit and short hospitalization rates were investigated in 9.5 million children aged <15 years registered with English family practices between April 2011 and March 2012 by using administrative hospital data. Six access categories ranked all practices according to patients' reported ability to schedule GP appointments; from national GP Patient Survey data. GP consulting hours were 8:00 am to 6:30 pm on weekdays. RESULTS: There were 3 074 616 ED visits (56% OOH) and 470 752 short hospitalizations over the 12 months studied. Children registered with practices in the highest access group compared with the lowest were 9% less likely to visit an ED (adjusted rate ratio: 0.91 [95% confidence interval: 0.89-93]), particularly OOH compared with consulting hours (10% vs 7%). Children in the highest access groups were equally likely to be admitted for a short stay. CONCLUSIONS: Increasing GP accessibility might alleviate the burden of ED visits from children, particularly during peak times OOH. Short hospitalizations may be more sensitive to other aspects of health systems.
BACKGROUND AND OBJECTIVE: Demand for unplanned hospital services is rising, and children are frequent users, especially where access to primary care is poor. In England, universal health care coverage entitles parents to see a general practitioner (GP) for first-contact care. However, access to GP appointments is variable, and few patients can see their own regular GP out of hours (OOH). The goal of this study explored the association between access to GPs , emergency department (ED) visits and short hospitalizations (<2 days) in children in England. METHODS: ED visit and short hospitalization rates were investigated in 9.5 million children aged <15 years registered with English family practices between April 2011 and March 2012 by using administrative hospital data. Six access categories ranked all practices according to patients' reported ability to schedule GP appointments; from national GP Patient Survey data. GP consulting hours were 8:00 am to 6:30 pm on weekdays. RESULTS: There were 3 074 616 ED visits (56% OOH) and 470 752 short hospitalizations over the 12 months studied. Children registered with practices in the highest access group compared with the lowest were 9% less likely to visit an ED (adjusted rate ratio: 0.91 [95% confidence interval: 0.89-93]), particularly OOH compared with consulting hours (10% vs 7%). Children in the highest access groups were equally likely to be admitted for a short stay. CONCLUSIONS: Increasing GP accessibility might alleviate the burden of ED visits from children, particularly during peak times OOH. Short hospitalizations may be more sensitive to other aspects of health systems.
Authors: Lisa L Cook; Richard P Golonka; Charles M Cook; Robin L Walker; Peter Faris; Shannon Spenceley; Richard Lewanczuk; Robert Wedel; Rebecca Love; Cheryl Andres; Susan D Byers; Tim Collins; Scott Oddie Journal: CMAJ Open Date: 2020-11-16
Authors: Katie Harron; Ruth Gilbert; David Cromwell; Sam Oddie; Astrid Guttmann; Jan van der Meulen Journal: BMJ Qual Saf Date: 2017-06-12 Impact factor: 7.035
Authors: Elke Jeschke; Alexandra Biermann; Christian Günster; Thomas Böhler; Günther Heller; Helmut D Hummler; Christoph Bührer Journal: Front Pediatr Date: 2016-03-22 Impact factor: 3.418