Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data.
Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data.
复制标题
获得初级保健和紧急入院途径的医院：国家医院行政数据的回顾性分析。
DOI：
10.1136/bmjqs-2015-004338
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发表时间：
2016-06
影响因子：
5.4
通讯作者：
Majeed A
中科院分区：
文献类型：
--
作者：
Cowling TE;Harris M;Watt H;Soljak M;Richards E;Gunning E;Bottle A;Macinko J;Majeed A
英国政府正在推行改善初级保健服务的政策，因为许多患者在无法获得合适的全科医生预约后前往事故和急诊（A 和 E）部门就诊。通过全科医生 (GP) 直接入院可避免使用 A 和 E，并可能降低住院总费用。它还可以增强全科医生和医院医生之间信息的连续性，从而可能改善医疗保健结果。确定初级保健服务是否与紧急入院途径相关——通过全科医生还是通过 A 和 E 科室。 2011-2012 年英国医院国家行政数据的回顾性分析。通过全科医生或 A 和 E 部门因紧急情况（计划外）入院 ≥1 晚的成年人构成了研究人群。初级保健可及性的衡量标准——在最后一次尝试中能够获得全科医生预约的患者的百分比——来自一项大型的、具有全国代表性的患者调查。使用多级逻辑回归来估计关联性，调整患者和入院特征。分析包括 2 322 112 例急诊入院（81.9% 通过 A 和 E 科室）。随着最后一次尝试获得全科预约的患者百分比增加 5 个单位，调整后的全科医生入院几率（相对于 A 和 E 入院）估计将增加 15%（OR 1.15，95% CI 1.12 至 1.17）。如果每次全科诊所 ≥95% 的预约尝试成功，则全科医生入院的概率估计为 19.6%。当 <80% 的预约尝试成功时，此概率降至 13.6%。假设入院总数没有变化，这相当于全科医生入院人数减少了 139 673 人（456 232 比 316 559）。英格兰各个地理区域的协会在方向上是一致的。在因急诊入院的医院住院患者中，注册到更容易获得的全科诊所的患者更有可能是通过全科医生（相对于 A 和 E 科室）入院的。这进一步证明，在英格兰，获得全科医疗与使用急诊医院服务有关。两种入学途径的相对优点仍不清楚。
The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. To determine whether primary care access is associated with the route of emergency admission—via a GP versus via an A and E department. Retrospective analysis of national administrative data from English hospitals for 2011–2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access—the percentage of patients able to get a general practice appointment on their last attempt—was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England. Among hospital inpatients admitted as an emergency, patients registered to more accessible general practices were more likely to have been admitted via a GP (vs an A and E department). This furthers evidence suggesting that access to general practice is related to use of emergency hospital services in England. The relative merits of the two admission routes remain unclear.