Background
In England, patients may be admitted to hospital as emergencies if, when they fall acutely ill or are injured: | |
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1 they or their carers take them to the emergency department of a hospital; | |
2 or they are taken to an emergency department by an ambulance; | |
3 or a general practitioner (GP; including out of-hours services) arranges emergency admission via an emergency department or directly to a hospital ward; | |
4 or by other routes, for example, through an outpatient department if a patient attends a clinic when seriously ill. |
Methods
Setting
Admissions
Practice characteristics
Access survey | |
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Telephone access | In general, are you satisfied with how easy it is to get through to someone on the phone at your doctor's surgery |
An appointment within 2 days | Think about the last time you tried to get an appointment with a doctor fairly quickly. Were you able to get the appointment on the same day or on the next 2 days the surgery was open |
Able to book an appointment in advance | Last time you wanted to, were you able to get an appointment with a doctor more than 2 full days in advance |
Able to make an appointment with a particular doctor. | Last time you wanted to, were you able to make an appointment with a particular doctor – even if it meant waiting longer |
Satisfaction with opening hours | Over the last 6 months or so, were you satisfied with the hours your GP surgery was open |
Quality and outcomes framework (% achievement)
| |
Clinical domain | 80 indicators relating to 19 clinical areas (coronary heart disease, stroke, hypertension, diabetes, COPD, epilepsy, hypothyroidism, cancer, palliative care, mental health, asthma, dementia, depression, chronic kidney disease, atrial fibrillation, obesity, learning disabilities, smoking) worth up to 655 points. |
Statistical methods
Variable | Incidence Rate Ratio (IRR) | 95% CI | P value (2-sided) |
---|---|---|---|
Distance (per km) | 0.9874 | 0.9762 to 0.9987 | 0.028 |
IMD (per unit) | 1.0014 | 0.9971 to 1.0057 | 0.519 |
Interaction term: | |||
Distance (per km) × IMD (per unit) | 1.0009 | 1.0004 to 1.0014 | 0.001 |
Age65≥ years (per 1%) | 1.0224 | 1.0095 to 1.0355 | 0.001 |
Males (per 1%) | 1.1535 | 1.0899 to 1.2209 | <0.001 |
White population (per 1%) | 1.0990 | 1.0520 to 1.1481 | <0.001 |
Interaction term: | |||
Males (per 1%) × White pop (per 1%) | 0.9981 | 0.9973 to 0.9989 | <0.001 |
Results
2006/7 | 2007/8+
| |||
---|---|---|---|---|
72 practices | 76 practices | |||
median
|
IQR
|
median
|
IQR
| |
Total QoF clinical points | 652 | 635 - 654 | 652 | 649 – 654 |
% Satisfied with phone access | 89 | 78 - 94 | 88 | 80 – 95 |
% Able to book 2 days ahead | 72 | 51 - 87 | 77 | 63 – 87 |
% Able to get an appt in 48 hours | 88 | 80 - 94 | 90 | 82 – 94 |
% Able to book with a preferred GP | 87 | 80 - 92 | 87 | 80 – 92 |
% Satisfied with opening hours | 86 | 81 - 89 | 82 | 77 – 86 |
Distance from hospital (km) | 8.9 | 3.5 – 15.3 | 10.2 | 3.6 – 15.3 |
% of practice male | 50 | 50 - 51 | 50 | 50 – 51 |
Age (% of practice patients aged 65+) | 14 | 12 - 16 | 14 | 12 – 16 |
Practice deprivation score (IMD) | 19 | 1 – 28 | 19 | 1 – 29 |
% of practice white ethnicity | 92 | 87 - 95 | 90 | 85 – 94 |
Practice list size | 7505 | 4454 - 11249 | 7561 | 4501 - 11542 |
Practice’s acute admissions per year | 589 | 376 - 1118 | 580 | 359 – 1132 |
Acute admissions per 1000 patients | 85 | 75 - 103 | 89 | 75 – 102 |
Access Survey Variable | Incidence Rate Ratio (IRR) | 95% CI | P value (2-sided) |
---|---|---|---|
Satisfaction with phone access (per 1%) | 0.9985 | 0.9952 to 1.0019 | 0.386 |
Booking within 48 hours (per 1%) | 1.0013 | 0.9966 to 1.0006 | 0.589 |
Booking >2 days in advance (per 1%) | 0.9992 | 0.9971 to 1.0013 | 0.468 |
Booking with preferred doctor (per 1%) | 0.9942 | 0.9894 to 0.9991 | 0.020 |
Satisfaction with opening hours (per 1%) | 0.9994 | 0.9926 to 1.0063 | 0.866 |
Variable | Incidence Rate Ratio (IRR) | 95% CI | P value (2-sided) |
---|---|---|---|
Distance (per km) | 0.9904 | 0.9811 to 0.9998 | 0.046 |
IMD (per unit) | 0.9680 | 0.9351 to 1.0020 | 0.065 |
Interaction term: | |||
Distance (per km) × IMD (per unit) | 1.0009 | 1.0004 to 1.0013 | 0.0005 |
Age65≥ years (per 1%) | 1.0228 | 1.0090 to 1.0367 | 0.001 |
Males (per 1%) | 1.1379 | 1.0720 to 1.2078 | <0.001 |
White population (per 1%) | 1.0874 | 1.0400 to 1.1369 | <0.001 |
Interaction term: | |||
Males (per 1%) × White pop (per 1%) | 0.9983 | 0.9975 to 0.9992 | 0.0001 |
% Able to book with a preferred GP (per 1%) | 0.9859 | 0.9766 to 0.9953 | 0.004 |
Interaction term: | |||
% Able to book with a preferred GP (per 1%) × IMD (per unit) | 1.0004 | 1.0000 to 1.0008 | 0.043 |
QoF clinical points (per 10 points) | 0.9987 | 0.9968 to 1.0107 | 0.829 |
For each1% absolute increase in % Able to book with a preferred GP | For the ‘typical’ (median) practice with 580 EAs per year – the corresponding decrease in EAs | Median value of ‘% Able to book with a preferred GP’ for each IMD Quintile | |
---|---|---|---|
Deprivation quintile 1 (typically 6 IMD points) - Least deprived | decrease of 1.2% in EAs | decrease of 6.8 EAs | 87% |
Deprivation quintile 2 (typically 13 IMD points) | decrease of 0.9% in EAs | decrease of 5.2 EAs | 87% |
Deprivation quintile 3 (typically 20 IMD points) | decrease of 0.6% in EAs | decrease of 3.6 EAs | 86% |
Deprivation quintile 4 (typically 25 IMD points) | decrease of 0.4% in EAs | decrease of 2.4 EAs | 89% |
Deprivation quintile 5 (typically 40 IMD points) - Most deprived | increase of 0.2% in EAs | increase of 1.1 EAs | 87% |