Referral outcomes of attendances at general practitioner-led urgent care centres in London, England: retrospective analysis of hospital administrative data
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
ABSTRACT
Objective To identify patient and attendance characteristics that are associated with onwards referral to co-located emergency departments (EDs) or other hospital specialty departments from general practitioner-led urgent care centres (UCCs) in northwest London, England.
Methods We conducted a retrospective analysis of administrative data recorded in the UCCs at Charing Cross and Hammersmith Hospitals, in northwest London, from October 2009 to December 2012. Attendances made by adults resident in England were included. Logistic regression was used to model the associations between the explanatory variables – age; sex; ethnicity; socioeconomic status; area of residence; distance to UCC; general practitioner registration; time, day, quarter, year, and UCC of attendance – and the outcome of onwards referral to the co-located EDs or other hospital specialty departments.
Results Of 243 042 included attendances, 74.1% were managed solely within the UCCs; without same-day referral to the EDs (16.8%) or other hospital specialty departments (5.7%), or deferred referral to a fracture, hand management, or soft tissue injury management clinic (3.3%). The adjusted odds of onwards referral was estimated to increase by 19% (OR 1.19, 95% CI 1.18 to 1.19) for a ten year increase in a patient’s age. Males, patients registered with a GP, and residents of less socioeconomically deprived areas were also more likely to be referred onwards from the UCCs.
Conclusions The majority of patients, across each category of all explanatory variables, were managed solely within the UCCs, though a large absolute number of patients were referred onwards each year. Several characteristics of patients and their attendances were associated with the outcome variable.
Objective To identify patient and attendance characteristics that are associated with onwards referral to co-located emergency departments (EDs) or other hospital specialty departments from general practitioner-led urgent care centres (UCCs) in northwest London, England.
Methods We conducted a retrospective analysis of administrative data recorded in the UCCs at Charing Cross and Hammersmith Hospitals, in northwest London, from October 2009 to December 2012. Attendances made by adults resident in England were included. Logistic regression was used to model the associations between the explanatory variables – age; sex; ethnicity; socioeconomic status; area of residence; distance to UCC; general practitioner registration; time, day, quarter, year, and UCC of attendance – and the outcome of onwards referral to the co-located EDs or other hospital specialty departments.
Results Of 243 042 included attendances, 74.1% were managed solely within the UCCs; without same-day referral to the EDs (16.8%) or other hospital specialty departments (5.7%), or deferred referral to a fracture, hand management, or soft tissue injury management clinic (3.3%). The adjusted odds of onwards referral was estimated to increase by 19% (OR 1.19, 95% CI 1.18 to 1.19) for a ten year increase in a patient’s age. Males, patients registered with a GP, and residents of less socioeconomically deprived areas were also more likely to be referred onwards from the UCCs.
Conclusions The majority of patients, across each category of all explanatory variables, were managed solely within the UCCs, though a large absolute number of patients were referred onwards each year. Several characteristics of patients and their attendances were associated with the outcome variable.
Date Issued
2015-09-22
Date Acceptance
2015-08-26
Citation
Emergency Medicine Journal, 2015, 33, pp.200-207
ISSN
1472-0213
Publisher
BMJ Publishing Group
Start Page
200
End Page
207
Journal / Book Title
Emergency Medicine Journal
Volume
33
Copyright Statement
© 2016, BMJ Publishing Group Ltd and the British Association for Accident and Emergencey Medicine. Referral outcomes of attendances at general practitioner led urgent care centres in London, England: retrospective analysis of hospital administrative data
Thomas E Cowling, Farzan Ramzan, Tim Ladbrooke, Hugh Millington, Azeem Majeed, Shamini Gnani
Emerg Med J 2016;33:3 200-207 Published Online First: 22 September 2015 doi:10.1136/emermed-2014-204603
Thomas E Cowling, Farzan Ramzan, Tim Ladbrooke, Hugh Millington, Azeem Majeed, Shamini Gnani
Emerg Med J 2016;33:3 200-207 Published Online First: 22 September 2015 doi:10.1136/emermed-2014-204603
Subjects
emergency care systems, emergency departments
emergency care systems, primary care
hospitalisations
Emergency & Critical Care Medicine
1103 Clinical Sciences
1110 Nursing
1117 Public Health And Health Services
Publication Status
Published