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.
Aged
Aged, 80 and over
Continuity of Patient Care
/ organization & administration
Emergency Service, Hospital
/ organization & administration
England
Female
General Practitioners
Health Policy
Humans
Male
Patient Admission
/ statistics & numerical data
Prospective Studies
Quality Improvement
Risk
State Medicine
health policy
organisation of health services
primary care
public health
research methods
statistics &
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
23 09 2019
23 09 2019
Historique:
entrez:
25
9
2019
pubmed:
25
9
2019
medline:
2
10
2020
Statut:
epublish
Résumé
To investigate whether the introduction of a named general practitioner (GP, family physician) improved patients' healthcare for patients aged 75 and over in England. Random 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. Prospective 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. National Health Service policy to introduce a named accountable GP for patients aged over 74 in April 2014. (A) Continuity of care index-score, (B) risk of emergency hospital admissions, (C) number of emergency hospital admissions. The 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). The introduction of the named GP scheme was not associated with improvements in either continuity of care or rates of unplanned hospitalisation.
Identifiants
pubmed: 31548353
pii: bmjopen-2019-029103
doi: 10.1136/bmjopen-2019-029103
pmc: PMC6773345
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e029103Commentaires et corrections
Type : CommentIn
Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
PLoS One. 2014 Jun 18;9(6):e99825
pubmed: 24941260
BMJ. 2011 Jun 28;342:d3590
pubmed: 21712336
Br J Gen Pract. 2018 Jun;68(671):e420-e426
pubmed: 29739778
BMJ Open. 2013 Aug 19;3(8):e003482
pubmed: 23959760
J Affect Disord. 2016 Jun;197:182-8
pubmed: 26994436
Med Care. 1976 Jul;14(7):625-36
pubmed: 940406
BMJ Open. 2014 May 23;4(5):e004746
pubmed: 24860000
BMJ. 2014 Jan 27;348:g330
pubmed: 24468469
Lancet. 2016 Jun 4;387(10035):2323-2330
pubmed: 27059888
Br J Gen Pract. 2016 Aug;66(649):396-7
pubmed: 27481958
Int J Integr Care. 2016 Mar 31;16(1):6
pubmed: 27616950
Int J Epidemiol. 2015 Jun;44(3):827-36
pubmed: 26050254
Med Care. 1977 Apr;15(4):347-9
pubmed: 859364
BMJ. 2017 Feb 1;356:j84
pubmed: 28148478
BMJ Open. 2014 Apr 23;4(4):e004952
pubmed: 24760353
BMJ Open. 2016 Sep 16;6(9):e011422
pubmed: 27638492
Br J Gen Pract. 2009 Apr;59(561):e134-41
pubmed: 19341548
BMJ Open. 2015 Dec 15;5(12):e009010
pubmed: 26671955
BMC Fam Pract. 2013 May 31;14:72
pubmed: 23725212
J Eval Clin Pract. 2010 Oct;16(5):947-56
pubmed: 20553366
Ann Fam Med. 2017 Nov;15(6):515-522
pubmed: 29133489
Br J Gen Pract. 2015 Aug;65(637):e545-51
pubmed: 26212851
Br J Gen Pract. 2012 Nov;62(604):e750-6
pubmed: 23211178