Emergency hospital admissions for asthma and access to primary care: cross-sectional analysis
Emergency hospital admissions for asthma and access to primary care: cross-sectional analysis
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DOI：
10.3399/bjgp16x686089
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发表时间：
2016-08-01
影响因子：
5.9
通讯作者：
Steel, Nicholas
中科院分区：
文献类型：
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作者：
Fleetcroft, Robert;Noble, Michael;Steel, Nicholas
背景哮喘急诊入院治疗可能是哮喘急诊入院的一个重要决定因素，因为早期治疗哮喘可以防止病情恶化。目的确定获得初级保健是否与哮喘急诊入院有关。设计和设置对2010-2011年间英语实习数据进行横断面分析。方法采用负二项回归方法，探讨哮喘急诊入院与全科医生调查中患者报告的获得全科医疗服务的7项指标之间的关系，并对执业人群的特征进行对照。计算每个关联的发病率比(IRR)。结果总共有7806例(95%)的实践具有所有变量的数据。哮喘患者3134 106人，急诊哮喘患者55 570人。综合得分较高的实践的入院率较低(变量0.679中10%的变化调整后的内部收益率，95%CI=0.665至0.708)。在执业人群中白人比例较高的做法，以及在质量和结果框架指标“过去15个月哮喘审查”中表现较差的做法，入院人数较高(哮喘6例)。假设这些联系是因果的，10%的较高准入分数与这些做法每年减少17837例住院有关。结论患者报告的准入越高，哮喘的紧急入院率越低。政策制定者应该考虑改善获得初级保健的机会，作为帮助防止哮喘紧急入院的一种潜在方式。
BackgroundAccess to general practices may be an important determinant of emergency admissions for asthma, as early treatment of exacerbations has been shown to prevent deterioration.AimTo determine whether access to primary care is associated with emergency admissions for asthma.Design and settingCross-sectional analysis of data from English practices in 2010-2011.MethodNegative binomial regression was used to explore the associations between emergency admissions for asthma and seven measures of patient-reported access to general practice services taken from the GP Patient Survey, controlled for the characteristics of practice populations. Incidence rate ratios (IRR) were calculated for each association.ResultsIn total 7806 (95%) of practices had data for all variables. There were 3 134 106 patients with asthma, and there were 55 570 emergency admissions with asthma. Admission rates were lower in practices with a higher composite access score (adjusted IRR for 10% change in variable 0.679, 95% CI = 0.665 to 0.708). Admissions were higher in those practices with higher proportions of the practice population who were white, and in practices with lower performance in the Quality and Outcomes Framework indicator 'asthma review in past 15 months' (Asthma 6). Assuming these associations were causal, a higher access score of 10% was associated with a decrease of 17 837 admissions per year for these practices.ConclusionPractices with higher patient-reported access had lower rates of emergency admissions for asthma. Policymakers should consider improving access to primary care as one potential way to help prevent emergency hospital admissions for asthma.