Background
Methods
Study design and setting
2009/10 (N = 5711) | 2010/11 (N = 6793) | 2011/12(N = 6903) | 2012/13 (N = 7091) | |||||
---|---|---|---|---|---|---|---|---|
Median | Interquartile range | Median | Interquartile range | Median | Interquartile range | Median | Interquartile range | |
General practice population | 6807 | 3650, 9153 | 6340 | 3822, 9582 | 6439 | 3925, 9717 | 6459 | 3929, 9736 |
Response rate GPPS | 42.7 | 34.3, 49.1 | 40.9 | 32.9, 47.5 | 42.1 | 35.2, 48.5 | 39.6 | 32.1, 46.0 |
Pct. of patients 65+ | 34.1 | 28.5, 38.3 | 34.3 | 29.3, 38.4 | 34.6 | 29.9, 38.5 | 34.5 | 29.7, 38.5 |
Pct. of patients female | 57.4 | 55.6, 59.1 | 57.5 | 55.9, 59.1 | 57.6 | 56.0, 59.1 | 57.5 | 55.9, 59.1 |
Pct. of patients UK white | 91.5 | 74.5, 95.5 | 92.1 | 79.6, 95.6 | 92.6 | 82.6, 95.7 | 92.5 | 81.9, 95.7 |
Pct. of patients unemployed | 3.5 | 2.2, 6.1 | 3.3 | 2.1, 5.6 | 3.2 | 2.0, 5.2 | 3.2 | 2.0, 5.3 |
Male life expectancy 2006–2010 | 78.1 | 76.3, 79.8 | 78.2 | 76.4, 79.8 | 78.3 | 76.5, 79.8 | 78.3 | 76.5, 79.8 |
Pct. of patients satisfied with open. Hours | 82.9 | 78.9, 86.4 | 83.0 | 79.3, 86.5 | 83.3 | 79.5, 86.9 | 83.2 | 79.4, 86.8 |
Pct. of patients felt wait far too long | 5.1 | 2.9, 8.6 | 5.1 | 2.9, 8.4 | 4.9 | 2.7, 8.1 | 4.9 | 2.8, 8.1 |
Pct. of patients having pref. GP | 62.0 | 54.2, 68.7 | 62.6 | 54.6, 69.1 | 62.8 | 54.9, 69.3 | 62.8 | 54.8, 69.3 |
Pct. of patients saw pref. GP often | 73.2 | 62.8, 82.5 | 73.5 | 63.1, 82.6 | 74.0 | 63.9, 83.1 | 73.9 | 63.8, 83.1 |
Std. self-ref. WiC attendance rate | 0.1 | 0.0, 0.3 | 0.1 | 0.0, 0.3 | 0.1 | 0.0, 0.3 | 0.1 | 0.0, 0.3 |
Std. self-ref. MIU attendance rate | 3.2 | 1.3, 23.5 | 3.0 | 1.3, 21.9 | 3.0 | 1.3, 22.3 | 3.0 | 1.3, 21.6 |
Std. self-ref. discharged ED attendance rate per 1000 general practice population | 81.2 | 45.9, 116.0 | 85.8 | 56.2, 120.1 | 90.3 | 64.1, 124.9 | 92.3 | 63.0, 126.3 |
Combined ED, MIU & WiC attendance rate per 1000 general practice population | 93.6 | 57.8, 130.4 | 99.9 | 69.5, 136.7 | 116.1 | 84.3, 154.6 | 123.5 | 89.9, 166 |
Rurality | Pct. | Pct. | Pct. | Pct. | ||||
Urban conurbation | 50.2 | 44.7 | 42.9 | 43.0 | ||||
cities and towns | 35.9 | 40.4 | 40.9 | 41.3 | ||||
rural | 13.9 | 14.9 | 16.1 | 15.7 |
Outcome measures
Measures of English general practice characteristics
Access to English general practice
Continuity of care
Measures of English general practice population demographics
Measures of local availability of MIU and WiC and their attendance rates
Statistical methods
Results
Time-trend
Variances in English general practice and population characteristics
N = 26,498 | Between PCT variance | Between general Practice variance | Within general practice variance |
---|---|---|---|
Time specific pct. 65+ | 25.7 | 37.7 | 7.6 |
Time specific pct. Female patients | 0.8 | 5.9 | 8.3 |
Time specific pct. UK-white patients | 327.7 | 126.4 | 7.0 |
Time specific pct. Unemployed patients | 4.7 | 5.2 | 2.6 |
Time specific pct. Satisfied open hours | 6.5 | 25.7 | 11.2 |
Time specific pct. Waited too long | 4.8 | 23.1 | 5.3 |
Time specific pct. Had pref. GP | 16.6 | 147.6 | 21.0 |
Time specific pct. Often spoke to pref. GP | 19.3 | 170.8 | 33.8 |
Time specific WiC attendance rate | 184.4 | 0 | 441.1 |
Time specific MIU attendance rate | 902.7 | 872.9 | 1006.6 |
Self-referred discharged ED attendance
Between practice variance: Time average effects of the general practice characteristics
Fixed part | b-coef. | 95% CI |
---|---|---|
Intercept | 432.194*** | |
2010–11 ref. 2009–10 | 9.624*** | 8.672,10.575 |
2011–12 ref. 2009–10 | 17.340*** | 16.120,18.560 |
2012–13 ref. 2009–10 | 18.279*** | 16.843,19.714 |
Time specific pct. 65+ | −0.044 | −0.176,0.089 |
Time average pct. 65+ | 0.677*** | 0.502,0.852 |
Time specific pct. Female patients | −0.061 | −0.184,0.063 |
Time average pct. Female patients | 0.393** | 0.124,0.662 |
Time specific pct. UK-white patients | −0.063 | −0.198,0.072 |
Time average pct. UK-white patients | −0.008 | −0.161,0.146 |
Time specific pct. Unemployed patients | −0.011 | −0.233,0.211 |
Time average pct. Unemployed patients | 2.255*** | 1.822,2.688 |
Time specific pct. Satisfied open hours | −0.092 | −0.204,0.019 |
Time average pct. Satisfied open hours | 0.007 | −0.163,0.177 |
Time specific pct. Waited too long | 0.099 | −0.061,0.258 |
Time average pct. Waited too long | 0.224* | 0.015,0.433 |
Time specific pct. Had pref. GP | 0.013 | −0.065,0.091 |
Time average pct. Had pref. GP | −0.116* | −0.209,-0.024 |
Time specific pct. Often spoke to pref. GP | −0.047 | −0.110,0.017 |
Time average pct. Often spoke to pref. GP | 0.036 | −0.047,0.118 |
Time specific WiC attendance rate | −0.011 | −0.028,0.007 |
Time average WiC attendance rate | −0.219*** | −0.279,-0.160 |
Time specific MIU attendance rate | −0.205*** | −0.216,-0.194 |
Time average MIU attendance rate | −0.063*** | −0.084,-0.041 |
Cities and towns ref. urban conurbation | 4.083** | 1.237,6.930 |
Rural areas ref. urban conurbation | −8.406*** | −11.559,-5.254 |
Male life expectancy 2006/10 | −4.860*** | −5.291,-4.428 |
local availability of MIU | 2.108*** | 1.082,3.134 |
local availability of WiC | 4.025*** | 2.518,5.532 |
Random components of variance | ||
PCT level: Intercept | 862.313*** | 664.770,1059.857 |
General practice level: Intercept | 465.105*** | 443.814,486.395 |
Year level: Intercept | 629.433*** | 616.768,642.099 |
Statistics | ||
N | 26,498 | |
deviance | 256,143.23 | |
Log likelihood | −128,071.62 |
Within practice variance: time specific effects of the general practice characteristics
Combined self-referred discharged ED and self-referred WiC and MIU attendances
Fixed part | b-coef. | 95% CI |
---|---|---|
Intercept | 461.627*** | |
2010–11 ref. 2009–10 | 11.973*** | 10.445,13.502 |
2011–12 ref. 2009–10 | 33.744*** | 31.894,35.594 |
2012–13 ref. 2009–10 | 43.880*** | 41.722,46.038 |
Time specific pct. 65+ | −0.029 | −0.244,0.186 |
Time average pct. 65+ | 1.071*** | 0.801,1.342 |
Time specific pct. Female patients | −0.087 | −0.288,0.114 |
Time average pct. Female patients | 0.530** | 0.133,0.927 |
Time specific pct. UK-white patients | −0.338** | −0.558,-0.119 |
Time average pct. UK-white patients | 0.366** | 0.123,0.609 |
Time specific pct. Unemployed patients | −0.094 | −0.455,0.267 |
Time average pct. Unemployed patients | 3.153*** | 2.507,3.798 |
Time specific pct. Satisfied open hours | −0.264** | −0.445,-0.082 |
Time average pct. Satisfied open hours | 0.107 | −0.151,0.365 |
Time specific pct. Waited too long | −0.034 | −0.294,0.226 |
Time average pct. Waited too long | 0.542** | 0.218,0.866 |
Time specific pct. Had pref. GP | 0.050 | −0.077,0.176 |
Time average pct. Had pref. GP | −0.113 | −0.258,0.033 |
Time specific pct. Often spoke to pref. GP | 0.022 | −0.081,0.125 |
Time average pct. Often spoke to pref. GP | −0.030 | −0.158,0.098 |
Cities and towns ref. urban conurbation | −5.350** | −9.361,-1.339 |
Rural areas ref. urban conurbation | −18.288*** | −22.740,-13.836 |
Male life expectancy 2006/10 | −5.446*** | −6.062,-4.830 |
Random components of variance | ||
PCT level: Intercept | 1590.901*** | 1225.077,1956.726 |
General practice level: Intercept | 833.953*** | 790.224,877.681 |
Year level: Intercept | 1675.340*** | 1641.657,1709.024 |
Statistics | ||
N | 26,498 | |
deviance | 280,065.22 | |
Log likelihood | −140,032.61 |