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Do hospitalisations for Ambulatory Care Sensitive Conditions reflect low access to primary care? An observational cohort study of primary care utilisation prior to hospitalisation

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Title: Do hospitalisations for Ambulatory Care Sensitive Conditions reflect low access to primary care? An observational cohort study of primary care utilisation prior to hospitalisation
Authors: Vuik, SI
Fontana, G
Mayer, E
Darzi, A
Item Type: Journal Article
Abstract: Objectives To explore whether hospitalisations for ambulatory care sensitive conditions (ACSCs) are associated with low access to primary care. Design Observational cohort study over 2008 to 2012 using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases. Setting English primary and secondary care. Participants A random sample of 300 000 patients. Main outcome measures Emergency hospitalisation for an ACSC. Results Over the long term, patients with ACSC hospitalisations had on average 2.33 (2.17 to 2.49) more general practice contacts per 6 months than patients with similar conditions who did not require hospitalisation. When accounting for the number of diagnosed ACSCs, age, gender and GP practice through a nested case–control method, the difference was smaller (0.64 contacts), but still significant (p<0.001). In the short-term analysis, measured over the 6 months prior to hospitalisation, patients used more GP services than on average over the 5 years. Cases had significantly (p<0.001) more primary care contacts in the 6 months before ACSC hospitalisations (7.12, 95% CI 6.95 to 7.30) than their controls during the same 6 months (5.57, 95% CI 5.43 to 5.72). The use of GP services increased closer to the time of hospitalisation, with a peak of 1.79 (1.74 to 1.83) contacts in the last 30 days before hospitalisation. Conclusions This study found no evidence to support the hypothesis that low access to primary care is the main driver of ACSC hospitalisations. Other causes should also be explored to understand how to use ACSC admission rates as quality metrics, and to develop the appropriate interventions.
Issue Date: 21-Aug-2017
Date of Acceptance: 5-Jul-2017
URI: http://hdl.handle.net/10044/1/50064
DOI: https://dx.doi.org/10.1136/bmjopen-2016-015704
ISSN: 2044-6055
Publisher: BMJ Publishing Group: Open Access
Journal / Book Title: BMJ Open
Volume: 7
Copyright Statement: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Sponsor/Funder: Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: RDB04 79560
Keywords: ACSC hospitalisations
access to care
integrated care
primary care quality
Publication Status: Published
Article Number: e015704
Appears in Collections:Division of Surgery
Faculty of Medicine



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