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Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study

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  • Thomas E Cowling
  • Elizabeth V Cecil
  • Michael A Soljak
  • John Tayu Lee
  • Christopher Millett
  • Azeem Majeed
  • Robert M Wachter
  • Matthew J Harris

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

Suggested Citation

  • Thomas E Cowling & Elizabeth V Cecil & Michael A Soljak & John Tayu Lee & Christopher Millett & Azeem Majeed & Robert M Wachter & Matthew J Harris, 2013. "Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-6, June.
    • Handle: RePEc:plo:pone00:0066699
    DOI: 10.1371/journal.pone.0066699
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    Citations

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    Cited by:

    1. Dolton, Peter & Pathania, Vikram, 2016. "Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening," Journal of Health Economics, Elsevier, vol. 49(C), pages 193-208.
    2. Bhalotra, Sonia & Nunes, Letícia & Rocha, Rudi, 2023. "Emergency Care Centers, Hospital Performance and Population Health," CAGE Online Working Paper Series 659, Competitive Advantage in the Global Economy (CAGE).
    3. Litchfield, Ian & Kingston, Beth & Narga, Dee & Turner, Alice, 2022. "The move towards integrated care: Lessons learnt from managing patients with multiple morbidities in the UK," Health Policy, Elsevier, vol. 126(8), pages 777-785.
    4. Enrique Pino-Moya & Mónica Ortega-Moreno & Juan Gómez-Salgado & Carlos Ruiz-Frutos, 2018. "Determining factors for the increase in self-referrals to the Emergency Department of a rural hospital in Huelva (Spain)," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-13, November.
    5. Sonia Bhalotra & Letícia Nunes & Rudi Rocha, 2020. "Urgent Care Centers, Hospital Performance and Population Health," Working Papers 10, Instituto de Estudos para Políticas de Saúde.
    6. Hong, Michael & Thind, Amardeep & Zaric, Gregory S. & Sarma, Sisira, 2020. "The impact of improved access to after-hours primary care on emergency department and primary care utilization: A systematic review," Health Policy, Elsevier, vol. 124(8), pages 812-818.
    7. McCormick, Barry & Nicodemo, Catia & Redding, Stuart, 2021. "Will policy to constrain GP referrals damage health? Evidence using practice level NHS emergency admissions administrative data," Social Science & Medicine, Elsevier, vol. 270(C).
    8. Friebel, Rocco & Fisher, Rebecca & Deeny, Sarah R. & Gardner, Tim & Molloy, Aoife & Steventon, Adam, 2019. "The implications of high bed occupancy rates on readmission rates in England: A longitudinal study," Health Policy, Elsevier, vol. 123(8), pages 765-772.
    9. Megha Swami & Hugh Gravelle & Anthony Scott & Jenny Williams, 2018. "Hours worked by general practitioners and waiting times for primary care," Health Economics, John Wiley & Sons, Ltd., vol. 27(10), pages 1513-1532, October.
    10. Laberge, Maude & Gaudreault, Myriam, 2019. "Promoting access to family medicine in Québec, Canada: Analysis of bill 20, enacted in November 2015," Health Policy, Elsevier, vol. 123(10), pages 901-905.
    11. Behrens, Doris A. & Morgan, Jennifer S. & Krczal, Eva & Harper, Paul R. & Gartner, Daniel, 2023. "Still looking in the wrong place: Literature-based evidence of why patients really attend an emergency department," Socio-Economic Planning Sciences, Elsevier, vol. 90(C).
    12. Thomson, Michael, 2019. "Who had access to doctors before and after new universal capitated subsidies in New Zealand?," Health Policy, Elsevier, vol. 123(8), pages 756-764.
    13. Pinchbeck, Edward W., 2019. "Convenient primary care and emergency hospital utilisation," Journal of Health Economics, Elsevier, vol. 68(C).
    14. Lippi Bruni, Matteo & Mammi, Irene & Ugolini, Cristina, 2016. "Does the extension of primary care practice opening hours reduce the use of emergency services?," Journal of Health Economics, Elsevier, vol. 50(C), pages 144-155.
    15. Victoria Barham & Olga Milliken, 2015. "Payment Mechanisms and the Composition of Physician Practices: Balancing Cost‐Containment, Access, and Quality of Care," Health Economics, John Wiley & Sons, Ltd., vol. 24(7), pages 895-906, July.

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