scholarly journals The impact of a named GP scheme on continuity of care and emergency hospital admission: a cohort study among older patients in England, 2012–2016

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029103 ◽  
Author(s):  
Peter Tammes ◽  
Rupert A Payne ◽  
Chris Salisbury ◽  
Melanie Chalder ◽  
Sarah Purdy ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Continuity Of Care ◽  
Hospital Admissions ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Post Intervention ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions ◽  
Emergency Hospital Admission ◽  
The Impact

ObjectiveTo investigate whether the introduction of a named general practitioner (GP, family physician) improved patients’ healthcare for patients aged 75 and over in England.SettingRandom sample of 27 500 patients aged 65 to 84 in 2012 within 139 English practices from the Clinical Practice Research Datalink linked with Hospital Episode Statistics.DesignProspective cohort approach, measuring patients’ GP consultations and emergency hospital admissions 2 years before/after the intervention. Patients were grouped in (i) aged over 74 and (ii) younger than 75 in both periods in order to compare who were or were not subject to the intervention. Adjusted associations between the named GP scheme, continuity of care and emergency hospital admission were examined using multilevel modelling.InterventionNational Health Service policy to introduce a named accountable GP for patients aged over 74 in April 2014.Main outcome measures(A) Continuity of care index-score, (B) risk of emergency hospital admissions, (C) number of emergency hospital admissions.ResultsThe intervention was associated with a decrease in continuity index-scores of −0.024 (95% CI −0.030 to −0.018, p<0.001); there were no differences in the decrease between the two age groups (−0.005, 95% CI −0.014 to 0.005). In the pre-intervention and post-intervention periods, respectively, 15.4% and 19.4% patients had an emergency admission. The probability of an emergency hospital admission increased after the intervention (OR 1.156, 95% CI 1.064 to 1.257, p=0.001); this increase was bigger for patients over 74 (relative OR 1.191, 95% CI 1.066 to 1.330, p=0.002). The average number of emergency hospital admissions increased after the intervention (rate ratio (RR) 1.178, 95% CI 1.103 to 1.259, p<0.001); this increase was greater for patients over 74 (relative RR 1.143, 95% CI 1.052 to 1.242, p=0.001).ConclusionThe introduction of the named GP scheme was not associated with improvements in either continuity of care or rates of unplanned hospitalisation.

scholarly journals Impact of emergency hospital admissions on patterns of primary care prescribing: a retrospective cohort analysis of electronic records in England

2020 ◽  
Vol 70 (695) ◽  
pp. e399-e405
Author(s):  
Rachel Denholm ◽  
Richard Morris ◽  
Sarah Purdy ◽  
Rupert Payne
Keyword(s):  
Hospital Admission ◽  
Retrospective Cohort ◽  
Hospital Admissions ◽  
Cohort Analysis ◽  
Post Discharge ◽  
Emergency Hospital ◽  
Obstetrics And Gynaecology ◽  
Emergency Hospital Admission ◽  
Retrospective Cohort Analysis ◽  
The Impact

BackgroundLittle is known about the impact of hospitalisation on prescribing in UK clinical practice.AimTo investigate whether an emergency hospital admission drives increases in polypharmacy and potentially inappropriate prescriptions (PIPs).Design and settingA retrospective cohort analysis set in primary and secondary care in England.MethodChanges in number of prescriptions and PIPs following an emergency hospital admission in 2014 (at admission and 4 weeks post-discharge), and 6 months post-discharge were calculated among 37 761 adult patients. Regression models were used to investigate changes in prescribing following an admission.ResultsEmergency attendees surviving 6 months (N = 32 657) had a mean of 4.4 (standard deviation [SD] = 4.6) prescriptions before admission, and a mean of 4.7 (SD = 4.7; P<0.001) 4 weeks after discharge. Small increases (<0.5) in the number of prescriptions at 4 weeks were observed across most hospital specialties, except for surgery (−0.02; SD = 0.65) and cardiology (2.1; SD = 2.6). The amount of PIPs increased after hospitalisation; 4.0% of patients had ≥1 PIP immediately before pre-admission, increasing to 8.0% 4 weeks post-discharge. Across hospital specialties, increases in the proportion of patients with a PIP ranged from 2.1% in obstetrics and gynaecology to 8.0% in cardiology. Patients were, on average, prescribed fewer medicines at 6 months compared with 4 weeks post-discharge (mean = 4.1; SD = 4.6; P<0.001). PIPs decreased to 5.4% (n = 1751) of patients.ConclusionPerceptions that hospitalisation is a consistent factor driving rises in polypharmacy are unfounded. Increases in prescribing post-hospitalisation reflect appropriate clinical response to acute illness, whereas decreases are more likely in patients who are multimorbid, reflecting a focus on deprescribing and medicines optimisation in these individuals. Increases in PIPs remain a concern.

scholarly journals The hospital admissions study in England: are there alternatives to emergency hospital admission?

1995 ◽  
Vol 49 (2) ◽  
pp. 194-199 ◽  
Author(s):  
J Coast ◽  
A Inglis ◽  
K Morgan ◽  
S Gray ◽  
M Kammerling ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Hospital Admissions ◽  
Emergency Hospital ◽  
Emergency Hospital Admission

The impact of heatwaves on mortality and emergency hospital admissions from non-external causes in Brisbane, Australia

2011 ◽  
Vol 69 (3) ◽  
pp. 163-169 ◽  
Author(s):  
Xiao Yu Wang ◽  
Adrian Gerard Barnett ◽  
Weiwei Yu ◽  
Gerry FitzGerald ◽  
Vivienne Tippett ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions ◽  
External Causes ◽  
The Impact

scholarly journals The association between mother’s alcohol consumption during pregnancy and their child’s educational attainment and risk of hospital admission by age 14

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Amrita Bandyopadhyay ◽  
Sinead Brophy ◽  
Simon Moore ◽  
Ashley Akbari ◽  
Shantini Paranjothy ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Alcohol Use ◽  
Educational Attainment ◽  
Hospital Admission ◽  
Cox Regression ◽  
Developmental Problems ◽  
Emergency Hospital ◽  
Emergency Hospital Admission ◽  
Increased Risk ◽  
The Impact

Background Heavy alcohol consumption by mothers during pregnancy is associated with developmental problems in their children. However, the impact of light to moderate consumption on the long-term health and educational attainment up to adolescence has not been established. Main Aim To investigate the association between mother’s alcohol use during pregnancy and health and educational attainment of their children up to age 14 years. Methods Millennium Cohort Study (MCS) children in Wales (1,838), with parental consent, were record-linked to emergency hospital admission data between birth and 14 years (1,795) and National Curriculum Key Stage-Three (KS3) (1,645) records within the Secure Anonymised Information Linkage (SAIL) Databank. Mother’s self-reported alcohol use during pregnancy was classified into a) abstain; b) light (1 - 2 units per week/occasion, 1 unit = 8g ethanol)); c) moderate (3 - 6 units per week/3-5 units per occasion) and d) heavy (> 6, dropped due to a paucity of data). Cox regression estimated the risk of emergency hospital admission and multivariate linear regression models estimated the difference in KS3 scores by exposure group. Results 71% of mothers abstained, 24% were light drinkers and 5% moderate. Light drinking was associated with children’s lower risk of emergency hospital admission (HR = 0.85, 95% CI 0.75 - 0.97) and better KS3 scores (β = 0.14, 95% CI 0.05 - 0.23) by age 14 years, when compared to abstaining mothers. Children of mothers who drank moderately had a comparable risk of emergency hospital admission (HR = 1.07, 95% CI 0.79 - 1.46) and a better KS3 score (β = 0.30, 95% CI 0.11 - 0.49), compared to abstaining mothers. Conclusion Consumption during pregnancy of 1-2 units of alcohol per week/occasion was neither associated with an increased risk of emergency hospital admission nor poor academic attainment in children up to 14 years of age.

scholarly journals The impact of structural changes to community nursing services on the rate of emergency hospital use of older people: a longitudinal ecological study of based on 140 primary care trusts in England

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Steven Wyatt ◽  
Robin Miller ◽  
Peter Spilsbury ◽  
Mohammed Amin Mohammed
Keyword(s):  
Older People ◽  
Ecological Study ◽  
Hospital Admissions ◽  
Mental Health Provider ◽  
Community Nursing ◽  
Content Type ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions ◽  
Nursing Services ◽  
The Impact

PurposeIn 2011, community nursing services were reorganised in England in response to a national policy initiative, but little is known about the impact of these changes. A total of three dominant approaches emerged: (1) integration of community nursing services with an acute hospital provider, (2) integration with a mental health provider and (3) the establishment of a stand-alone organisation, i.e. without structural integration. The authors explored how these approaches influenced the trends in emergency hospital admissions and bed day use for older people.Design/methodology/approachThe methodology was a longitudinal ecological study using panel data over a ten-year period from April 2006 to March 2016. This study’s outcome measures were (1) emergency hospital admissions and (2) emergency hospital bed use, for people aged 65+ years in 140 primary care trusts (PCTs) in England.FindingsThe authors found no statistically significant difference in the post-intervention trend in emergency hospital admissions between those PCTS that integrated community nursing services with an acute care provider and those integrated with a mental health provider (IRR 0.999, 95% CI 0.986–1.013) or those that did not structurally integrate services (IRR 0.996, 95% CI 0.982–1.010). The authors similarly found no difference in the trends for emergency hospital bed use.Research limitations/implicationsPCTs were abolished in 2011 and replaced by clinical commissioning groups in 2013, but the functions remain.Practical implicationsThe authors found no evidence that any one structural approach to the integration of community nursing services was superior in terms of reducing emergency hospital use in older people.Originality/valueAs far as the authors are aware, previous studies have not examined the impact of alternative approaches to integrating community nursing services on healthcare use.

scholarly journals Impact of a community respiratory service on emergency hospital admissions

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
K Levin ◽  
D Anderson ◽  
M Milligan ◽  
E Crighton
Keyword(s):  
Hospital Admissions ◽  
Emergency Admission ◽  
Primary Diagnosis ◽  
Relative Reduction ◽  
Emergency Admissions ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions ◽  
North East ◽  
Significant Change ◽  
The Impact

Abstract Background A community respiratory service was implemented in the North West of Glasgow in January 2013, comprising a team of physiotherapists, occupational therapists and support workers, to provide education, self-management advice, and, where appropriate, treatment at home, for COPD patients, to reduce the risk of hospital admission. This study measures the impact of the service on emergency admission to hospital. Methods COPD EAs were defined as emergency admissions to hospital with a primary diagnosis of COPD. Rate of COPD EAs per 1000 population aged 65 years+ in Glasgow City was compared before and after onset of the service, using segmented linear regression with 21-month pre- and 17-month post-intervention periods. COPD EAs for residents of South and North East Glasgow (S+NE) - areas with no such service in place - were used as a comparison group. The model adjusted for the rate of all-cause emergency admissions. Autoregressive terms were included in the model, as well as a fourier term to adjust for seasonality. Models were similarly run for outcome emergency admissions with COPD in any of the other five fields of diagnosis. Results Adjusting for all cause EAs and changes in S+NE, thus factoring out the impact of other initiatives that may have affected emergency admission to hospital, the impact of the service was found to be a level change of -0.33 (-0.51, -0.16) and a trend change of -0.03 (-0.05, -0.02) COPD EAs per 1000 per month. This is equivalent to a predicted reduction due to the service of -0.88 COPD EAs per 1000 popn per month, in March 2015, and a relative reduction of 35.8%. Rate of COPD EAs per month reduced over time after the introduction of the service (from the point of full staffing). Rate of EAs with COPD in a field of diagnosis other than primary saw no significant change in level or trend associated with the service. Conclusions The community respiratory service was associated with a significant reduction in the rate of COPD EAs. Key messages The Community Respiratory service was associated with reductions in emergency hospital admissions with COPD as a primary diagnosis. There was no significant change in emergency admissions with COPD as a secondary diagnosis, suggesting hospital attendance for patients with COPD overall reduced following the intervention.

scholarly journals Trends in healthcare use in children aged less than 15 years: a population-based cohort study in England from 2007 to 2017

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e033761 ◽  
Author(s):  
Judith Ruzangi ◽  
Mitch Blair ◽  
Elizabeth Cecil ◽  
Geva Greenfield ◽  
Alex Bottle ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Hospital Admissions ◽  
Population Based ◽  
Urgent Care ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Emergency Hospital ◽  
Outpatient Visits ◽  
Ed Visits

ObjectiveTo describe changing use of primary care in relation to use of urgent care and planned hospital services by children aged less than 15 years in England in the decade following major primary care reforms from 2007 to 2017DesignPopulation-based retrospective cohort study.MethodsWe used linked data from the Clinical Practice Research Datalink to study children’s primary care consultations and use of hospital care including emergency department (ED) visits, emergency and elective admissions to hospital and outpatient visits to specialists.ResultsBetween 1 April 2007 and 31 March 2017, there were 7 604 024 general practitioner (GP) consultations, 981 684 ED visits, 287 719 emergency hospital admissions, 2 253 533 outpatient visits and 194 034 elective admissions among 1 484 455 children aged less than 15 years. Age-standardised GP consultation rates fell (−1.0%/year) to 1864 per 1000 child-years in 2017 in all age bands except infants rising by 1%/year to 6722 per 1000/child-years in 2017. ED visit rates increased by 1.6%/year to 369 per 1000 child-years in 2017, with steeper rises of 3.9%/year in infants (780 per 1000 child-years in 2017). Emergency hospital admission rates rose steadily by 3%/year to 86 per 1000 child-years and outpatient visit rates rose to 724 per 1000 child-years in 2017.ConclusionsOver the past decade since National Health Service primary care reforms, GP consultation rates have fallen for all children, except for infants. Children’s use of hospital urgent and outpatient care has risen in all ages, especially infants. These changes signify the need for better access and provision of specialist and community-based support for families with young children.

scholarly journals Influence of Pharmaceutical Copayment on Emergency Hospital Admissions: A 1978–2018 Time Series Analysis in Spain

2021 ◽  
Vol 18 (15) ◽  
pp. 8009
Author(s):  
Antonio Palazón-Bru ◽  
Miriam Calvo-Pérez ◽  
Pilar Rico-Ferreira ◽  
María Anunciación Freire-Ballesta ◽  
Vicente Francisco Gil-Guillén ◽  
...  
Keyword(s):  
Time Series ◽  
Life Expectancy ◽  
Time Series Analysis ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Moving Average ◽  
Emergency Hospital ◽  
Admission Rates ◽  
Series Analysis ◽  
Emergency Hospital Admissions

No studies have evaluated the influence of pharmaceutical copayment on hospital admission rates using time series analysis. Therefore, we aimed to analyze the relationship between hospital admission rates and the influence of the introduction of a pharmaceutical copayment system (PCS). In July 2012, a PCS was implemented in Spain, and we designed a time series analysis (1978–2018) to assess its impact on emergency hospital admissions. Hospital admission rates were estimated between 1978 and 2018 each month using the Hospital Morbidity Survey in Spain (the number of urgent hospital admissions per 100,000 inhabitants). This was conducted for men, women and both and for all-cause, cardiovascular and respiratory hospital discharges. Life expectancy was obtained from the National Institute of Statistics. The copayment variable took a value of 0 before its implementation (pre-PCS: January 1978–June 2012) and 1 after that (post-PCS: July 2012–December 2018). ARIMA (Autoregressive Integrated Moving Average) (2,0,0)(1,0,0) models were estimated with two predictors (life expectancy and copayment implementation). Pharmaceutical copayment did not influence hospital admission rates (with p-values between 0.448 and 0.925) and there was even a reduction in the rates for most of the analyses performed. In conclusion, the PCS did not influence hospital admission rates. More studies are needed to design health policies that strike a balance between the amount contributed by the taxpayer and hospital admission rates.

scholarly journals Comparison of the impact of two national health and social care integration programmes on emergency hospital admissions

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marcello Morciano ◽  
Katherine Checkland ◽  
Mary Alison Durand ◽  
Matt Sutton ◽  
Nicholas Mays
Keyword(s):  
Social Care ◽  
Hospital Admissions ◽  
Emergency Admission ◽  
Emergency Admissions ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions ◽  
Care Integration ◽  
Health And Social Care ◽  
The Impact ◽  
Expert Support

Abstract Background Policy-makers expect that integration of health and social care will improve user and carer experience and reduce avoidable hospital use. [We] evaluate the impact on emergency hospital admissions of two large nationally-initiated service integration programmes in England: the Pioneer (November 2013 to March 2018) and Vanguard (January 2015 to March 2018) programmes. The latter had far greater financial and expert support from central agencies. Methods Of the 206 Clinical Commissioning Groups (CCGs) in England, 51(25%) were involved in the Pioneer programme only, 22(11%) were involved in the Vanguard programme only and 13(6%) were involved in both programmes. We used quasi-experimental methods to compare monthly counts of emergency admissions between four groups of CCGs, before and after the introduction of the two programmes. Results CCGs involved in the programmes had higher monthly hospital emergency admission rates than non-participants prior to their introduction [7.9 (95% CI:7.8–8.1) versus 7.5 (CI: 7.4–7.6) per 1000 population]. From 2013 to 2018, there was a 12% (95% CI:9.5–13.6%) increase in emergency admissions in CCGs not involved in either programme while emergency admissions in CCGs in the Pioneer and Vanguard programmes increased by 6.4% (95% CI: 3.8–9.0%) and 8.8% (95% CI:4.5–13.1%), respectively. CCGs involved in both initiatives experienced a smaller increase of 3.5% (95% CI:-0.3–7.2%). The slowdown largely occurred in the final year of both programmes. Conclusions Health and social care integration programmes can mitigate but not prevent rises in emergency admissions over the longer-term. Greater financial and expert support from national agencies and involvement in multiple integration initiatives can have cumulative effects.

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