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Exploring the relationship between general practice characteristics and attendance at Walk-in Centres, Minor Injuries Units and Emergency Departments in England 2009/10-2012/2013: A longitudinal study

Morris, Richard W.; Tammes, Peter; Brangan, Emer; Checkland, Kath; England, Helen; Huntley, Alyson; Lasserson, Daniel; MacKichan, Fiona; Salisbury, Chris; Wye, Lesley; Purdy, Sarah

Exploring the relationship between general practice characteristics and attendance at Walk-in Centres, Minor Injuries Units and Emergency Departments in England 2009/10-2012/2013: A longitudinal study Thumbnail


Authors

Richard W. Morris

Peter Tammes

Kath Checkland

Helen England

Alyson Huntley

Daniel Lasserson

Fiona MacKichan

Chris Salisbury

Lesley Wye

Sarah Purdy



Abstract

© 2017 The Author(s). Background: The UK National Health Service Emergency Departments (ED) have recently faced increasing attendance rates. This study investigated associations of general practice and practice population characteristics with emergency care service attendance rates. Methods: A longitudinal design with practice-level measures of access and continuity of care, patient population demographics and use of emergency care for the financial years 2009/10 to 2012/13. The main outcome measures were self-referred discharged ED attendance rate, and combined self-referred discharged ED, self-referred Walk-in Centre (WiC) and self-referred Minor Injuries Unit (MIU) attendance rate per 1000 patients. Multilevel models estimated adjusted regression coefficients for relationships between patients' emergency attendance rates and patients' reported satisfaction with opening hours and waiting time at the practice, proportion of patients having a preferred GP, and use of WiC and MIU, both between practices, and within practices over time. Results: Practice characteristics associated with higher ED attendance rates included lower percentage of patients satisfied with waiting time (0.22 per 1% decrease, 95%CI 0.02 to 0.43) and lower percentage having a preferred GP (0.12 per 1% decrease, 95%CI 0.02 to 0.21). Population influences on higher attendance included more elderly, more female and more unemployed patients, and lower male life-expectancy and urban conurbation location. Net reductions in ED attendance were only seen for practices whose WiC or MIU attendance was high, above the 60th centile for MIU and above the 75th centile for WiC. Combined emergency care attendance fell over time if more patients within a practice were satisfied with opening hours (-0.26 per 1% increase, 95%CI -0.45 to -0.08). Conclusion: Practices with more patients satisfied with waiting time, having a preferred GP, and using MIU and WIC services, had lower ED attendance. Increases over time in attendance at MIUs, and patient satisfaction with opening hours was associated with reductions in service use.

Journal Article Type Article
Acceptance Date Jul 28, 2017
Online Publication Date Aug 8, 2017
Publication Date Aug 8, 2017
Deposit Date Sep 26, 2019
Publicly Available Date Sep 27, 2019
Journal BMC Health Services Research
Electronic ISSN 1472-6963
Publisher BioMed Central
Peer Reviewed Peer Reviewed
Volume 17
Issue 1
DOI https://doi.org/10.1186/s12913-017-2483-x
Keywords longitudinal study, ‘emergency service, hospital’, primary health care, population characteristics, multilevel modelling, continuity of care, alternative health care service
Public URL https://uwe-repository.worktribe.com/output/3241095

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Exploring the relationship between general practice characteristics and attendance at Walk-in Centres, Minor Injuries Units and Emergency Departments in England 2009/ 10–2012/2013: a longitudinal study (513 Kb)
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http://creativecommons.org/licenses/by/4.0/

Publisher Licence URL
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Copyright Statement
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.


Exploring the Relationship between General Practice Characteristics and Attendance at Walk-in Centres, Minor Injuries Units and Emergency Departments in England 2009/10 - 2012/2013: a Longitudinal Study (953 Kb)
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