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Patient experience of general practice and use of emergency hospital services in England: regression analysis of national cross-sectional time series data
  1. Thomas E Cowling1,2,
  2. Azeem Majeed1,
  3. Matthew J Harris1
  1. 1Department of Primary Care and Public Health, Imperial College London, London, UK
  2. 2Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr Thomas E Cowling, Department of Primary Care and Public Health, Imperial College London, Reynolds Building, St Dunstan’s Road, London W6 8RP, UK; t.cowling{at}imperial.ac.uk

Abstract

Background The UK Government has introduced several national policies to improve access to primary care. We examined associations between patient experience of general practice and rates of visits to accident and emergency (A&E) departments and emergency hospital admissions in England.

Methods The study included 8124 general practices between 2011–2012 and 2013–2014. Outcome measures were annual rates of A&E visits and emergency admissions by general practice population, according to administrative hospital records. Explanatory variables included three patient experience measures from the General Practice Patient Survey: practice-level means of experience of making an appointment, satisfaction with opening hours and overall experience (on 0–100 scales). The main analysis used random-effects Poisson regression for cross-sectional time series. Five sensitivity analyses examined changes in model specification.

Results Mean practice-level rates of A&E visits and emergency admissions increased from 2011–2012 to 2013–2014 (310.3–324.4 and 98.8–102.9 per 1000 patients). Each patient experience measure decreased; for example, mean satisfaction with opening hours was 79.4 in 2011–2012 and 76.6 in 2013–2014. In the adjusted regression analysis, an SD increase in experience of making appointments (equal to 9 points) predicted decreases of 1.8% (95% CI −2.4% to −1.2%) in A&E visit rates and 1.4% (95% CI −1.9% to −0.9%) in admission rates. This equalled 301 174 fewer A&E visits and 74 610 fewer admissions nationally per year. Satisfaction with opening hours and overall experience were not consistently associated with either outcome measure across the main and sensitivity analyses.

Conclusions Associations between patient experience of general practice and use of emergency hospital services were small or inconsistent. In England, realistic short-term improvements in patient experience of general practice may only have modest effects on A&E visits and emergency admissions.

  • general practice
  • emergency department
  • patient satisfaction
  • health services research
  • health policy

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Footnotes

  • Twitter @Azeem_Majeed

  • Contributors TEC is responsible for the whole of the work and is the guarantor. MJH and AM contributed to the interpretation of results and revisions of the article. All authors approved the published version.

  • Funding This report is independent research supported by the National Institute for Health Research (NIHR) (Doctoral Research Fellowship, Thomas Cowling, DRF-2013-06-142). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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