Quality of Primary Care and Hospital Admissions for Diabetes Mellitus in England

BackgroundSerious mental illness (SMI) is a set of chronic enduring conditions including schizophrenia and bipolar disorder. SMIs are associated with poor outcomes, high costs and high levels of disease burden. Primary care plays a central role in the care of people with a SMI in the English NHS. Good-quality primary care has the potential to reduce emergency hospital admissions, but also to increase elective admissions if physical health problems are identified by regular health screening of people with SMIs. Better-quality primary care may reduce length of stay (LOS) by enabling quicker discharge, and it may also reduce NHS expenditure.ObjectivesWe tested whether or not better-quality primary care, as assessed by the SMI quality indicators measured routinely in the Quality and Outcomes Framework (QOF) in English general practice, is associated with lower rates of emergency hospital admissions for people with SMIs, for both mental and physical conditions and with higher rates of elective admissions for physical conditions in people with a SMI. We also tested the impact of SMI QOF indicators on LOS and costs.DataWe linked administrative data from around 8500 general practitioner (GP) practices and from Hospital Episode Statistics for the study period 2006/7 to 2010/11. We identified SMI admissions by a mainInternational Classification of Diseases, 10th revision (ICD-10) diagnosis of F20–F31. We included information on GP practice and patient population characteristics, area deprivation and other potential confounders such as access to care. Analyses were carried out at a GP practice level for admissions, but at a patient level for LOS and cost analyses.MethodsWe ran mixed-effects count data and linear models taking account of the nested structure of the data. All models included year indicators for temporal trends.ResultsContrary to expectation, we found a positive association between QOF achievement and admissions, for emergency admissions for both mental and physical health. An additional 10% in QOF achievement was associated with an increase in the practice emergency SMI admission rate of approximately 1.9%. There was no significant association of QOF achievement with either LOS or cost. All results were robust to sensitivity analyses.ConclusionsPossible explanations for our findings are (1) higher quality of primary care, as measured by QOF may not effectively prevent the need for secondary care; (2) patients may receive their QOF checks post discharge, rather than prior to admission; (3) people with more severe SMIs, at a greater risk of admission, may select into practices that are better organised to provide their care and which have better QOF performance; (4) better-quality primary care may be picking up unmet need for secondary care; and (5) QOF measures may not accurately reflect quality of primary care. Patient-level data on quality of care in general practice is required to determine the reasons for the positive association of QOF quality and admissions. Future research should also aim to identify the non-QOF measures of primary care quality that may reduce unplanned admissions more effectively and could potentially be incentivised.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Asian Americans are less satisfied with the quality of primary care they receive than any other racial/ethnic group

PsycEXTRA Dataset ◽

10.1037/e556632006-007 ◽

2002 ◽

Keyword(s):

Primary Care ◽

Ethnic Group ◽

Asian Americans ◽

Quality Of Primary Care ◽

Racial Ethnic

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Study finds declining quality of primary care for elderly Medicare patients

PsycEXTRA Dataset ◽

10.1037/e556292006-007 ◽

2005 ◽

Keyword(s):

Primary Care ◽

Quality Of Primary Care ◽

Medicare Patients

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Enhancing Quality of Primary Care Using an Ambulatory ICU to Achieve a Patient- Centered Medical Home

Journal of Primary Care & Community Health ◽

10.1177/2150131911410063 ◽

2011 ◽

Vol 2 (4) ◽

pp. 234-239 ◽

Cited By ~ 6

Author(s):

Joy Lewis ◽

Alex Hoyt ◽

Rose M. Kakoza

Keyword(s):

Primary Care ◽

Medical Home ◽

Patient Centered Medical Home ◽

Patient Centered ◽

Quality Of Primary Care

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Effect of family practice contract services on the quality of primary care in Guangzhou, China: a cross-sectional study using PCAT-AE

BMJ Open ◽

10.1136/bmjopen-2017-021317 ◽

2018 ◽

Vol 8 (11) ◽

pp. e021317 ◽

Cited By ~ 8

Author(s):

Lina Li ◽

Chenwen Zhong ◽

Jie Mei ◽

Yuan Liang ◽

Li Li ◽

...

Keyword(s):

Primary Care ◽

Family Practice ◽

Assessment Tool ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Quality Of Primary Care ◽

Care Assessment ◽

First Contact

ObjectiveCurrent healthcare reform in China has an overall goal of strengthening primary care and establishing a family practice system based on contract services. The objective of this study was to determine whether contracting a general practitioner (GP) could improve quality of primary care.DesignA cross-sectional study using two-stage sampling conducted from June to September 2014. Propensity score matching (PSM) was employed to control for confounding between patients with and without contracted GP.SettingThree community health centres in Guangzhou, China.Participants698 patients aged 18–89 years.Main outcome measuresThe quality of primary care was measured using a validated Chinese version of primary care assessment tool (PCAT). Eight domains are included (first contact utilisation, accessibility, continuity, comprehensiveness, coordination, family-centredness, community orientation and cultural competence from patient’s perceptions).ResultsA total of 692 effective samples were included for data analysis. After PSM, 94 pairs of patients were matched between the patients with and without contracted GPs. The total PCAT score, continuity (3.12 vs 2.68, p<0.01), comprehensiveness (2.31 vs 2.04, p<0.01) and family-centredness (2.11 vs 1.79, p<0.01) were higher in patients who contracted GPs than those did not. However, the domains of first contact utilisation (2.74 vs 2.87, p=0.14) and coordination (1.76 vs 1.93, p<0.05) were lower among patients contracted with GPs than in those who did not.ConclusionOur findings demonstrated that patients who had a contracted GP tend to experience higher quality of primary care. Our study provided evidence for health policies aiming to promote the implementation of family practice contract services. Our results also highlight further emphases on the features of primary care, first contact services and coordination services in particular.

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Municipal Management, Infrastructure And Perception Of Users: A Description Of National Program For Improving Access And Quality Of Primary Care In The Brazilian Semiarid

International Archives of Medicine ◽

10.3823/2515 ◽

2017 ◽

Vol 10 ◽

Author(s):

Marília Gomes De Sousa Bezerra ◽

Roseanne De Sousa Nobre ◽

Artemizia Francisca De Sousa ◽

Maísa De Lima Claro

Keyword(s):

Primary Care ◽

Cross Sectional ◽

Unified Health System ◽

Quality Of Primary Care ◽

Brazilian Semiarid ◽

Municipal Management ◽

Access And Quality ◽

Objective Description

Introduction: The Ministry of Health with the aim of improving the service provided by the Unified Health System has been creating work tools to identify which points need to receive more attention to be optimized. Objective: Description of the role of municipal management, infrastructure assessment and perception of users of primary care. Method: Cross-sectional and descriptive study, conducted with Basic Units of Piauí municipality in 2015. The data were represented by tables. Results: 90% of the units reported receiving support for the planning and organization of the work process. Only 14, 81% of the units have equipment and supplies for proper operation. Users recommend the service in 92,62% of the cases. Conclusion: despite the precarious structure of the basic units of the county, the population still recognizes them as the best care.

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