Background Visits to emergency departments (ED) have been rising in many developed countries including the United Kingdom (UK) placing strain on health resources and budgets. Poor access to primary care is associated with higher ED attendance. In England, children are among the largest user groups of EDs each year, of which 90% are sent home. Yet parents prefer their child to be seen by a general practitioner for first contact care when their child has an acute problem. Restructuring of primary care provision in the community is thought to have impacted on access for children and could potentially be driving parents to use emergency care. The study aimed to investigate the relationship between ED visit rates and patient reported access.
Methods We used Hospital Episode Statistics data to determine ED visit rates in children aged 0–14 years between April 1, 2011, and March 31, 2012. We defined OOHs as visits in which arrival time was between 6pm and 8am. We linked, via the patient’s recorded practice, to national general practitioner (GP) Patient Survey data. We constructed population weighted tertiles defining practices as ‘good’, ‘moderately good’ and ‘poor’, according to the proportion of patients who reported they were able to get a GP appointment on their last contact. We applied a negative binomial model to estimate adjusted ED visit rate ratios according to patient reported access. We incorporated reported access/OOH visit time interactions. The rates were adjusted for child age, sex, practice level deprivation, GP supply and location factors.
Results One in 5 children aged less than 15 years visited an ED at least once in 2011/12 (2,002,754/9,458,000). The crude rate was 325 ED visits per 1,000 children (3,074,616/9,458,000). Children where most likely to visit EDs in the hours of 6 and 7pm, though overall OOHs had lower ED visits than in-hours: adjusted rate ratio (ARR) 0.66 95% CI (0.65, 0.66). Practices with good reported access had lower ED visit rates: ARR for good versus poor access 0.94 95% CI (0.93, 0.95). However, the relationship between better access and lower ED visit rates was only evident for OOHs visits.
Discussion Families registered with practices where it is reportedly difficult to see a GP are more likely to seek emergency healthcare for their child out of GP consulting hours.
- emergency department visits