Can Continuity Of Primary Care Decrease Unscheduled Secondary Care Use?

Date of ISAC Approval: 
15/09/2015
Lay Summary: 
NHS hospitals are often overwhelmed by people presenting to hospital for unexpected care, in particular attending their A&E departments, and then being admitted to hospital as an emergency. In considering reasons for this, it is natural to consider the potential influence of factors related to general practices where these people are registered. Sometimes the way practices are organised lead to their patients needing unplanned care from hospitals when they fall ill. In particular, we wish to determine whether having continuity of care (usually seeing the same doctor) can reduce the risk of having an unplanned hospital admission. We will use data from the CPRD, linked to "Hospital Episode Statistics" (HES), which tell us about patients' stays in hospital. This current pilot project will investigate whether the linked CPRD/HES data contains the right sort of information to answer our question. We will investigate data suitable for assessing continuity of care received by individual patients, and also the data which relate to emergency admissions and A&E attendance. In the present project, we will only assess data on 10,000 patients aged over 65. If the data do seem suitable, we will seek funding to carry out an analysis on the full CPRD dataset.
Technical Summary: 
Evidence suggests that many NHS patients presenting for unscheduled secondary care could be managed in primary care, thus aspects of general practice might be associated with unscheduled care. Current work by the investigators, including a published systematic review, suggest continuity of care as a potential influence. We will obtain data from CPRD, linked with Hospital Episode Statistics (HES) data concerning emergency hospital admissions in 2012-14. Our ultimate purpose is to examine whether better continuity of care (as defined by a ready-made index) is associated with fewer emergency admissions, after adjustment for relevant confounding factors. The purpose of the current proposal will be to investigate the suitability of the data to address this hypothesis. We will request data on 10,000 patients aged over 65: while this will not have sufficient power to address the ultimate hypothesis, it will allow us to estimate the emergency admission rate, and assess its concordance with official national averages. We will assess agreement between both emergency admissions and ED attendances apparent in GP records, and those recorded in HES and will investigate disagreement, especially concerning mode of referral and discharge. Emergency admissions will be our primary outcome, however we will investigate ED attendances recorded by GPs.
Health Outcomes to be Measured: 
Emergency admission to hospital
Collaborators: 

Professor Richard Morris - Chief Investigator - University of Bristol
Chris Salisbury - Researcher - University of Bristol
Dr Daniel Lasserson - Researcher - University of Birmingham
Fiona MacKichan - Researcher - University of Bristol
Dr Peter Tammes - Researcher - University of Bristol
Dr Sarah Purdy - Researcher - University of Bristol

Linkages: 
HES Admitted;ONS;Patient IMD;Practice IMD (Standard)