Background Many emergency admissions are deemed to be avoidable. There is a potential for several conditions, including angina, diabetes and chronic obstructive pulmonary disease (COPD), to be more appropriately treated in community and urgent care settings. The rate of emergency admissions for these conditions can be influenced by a number of factors. These include factors directly linked to health services, such as access to general practice, ambulance resources, emergency departments and hospitals. Other factors beyond the control of health services, such as deprivation and rurality, may also play a role.
Methods Directly age-standardised emergency admission rates were constructed at a county level for a series of urgent conditions for 2013–2015.
Based on methods adopted by a UK study, we examined the role of service level factors on these rates (block 2: availability and accessibility of services) having removed the effect of non-modifiable by service factors (block 1: population, geography and health factors).
A multivariate regression using forward stepwise regression within each block was used, beginning with variables from block 1. We then examined the association between the residuals from the first model and block 2 service level variables. Factors were included in the final model if the p-value was <0.05.
Results There were 2 28 435 emergency admissions for selected urgent conditions in 2013–2015. They accounted for 24.5% of all emergency admissions. Results from the first stepwise regression identified one significant non-modifiable by services factor, the regional unemployment rate. This accounted for 30% of the observed variation (R²=30%). Preliminary analysis indicates that factors concerning availability and access to primary care services and hospitals accounted for an additional 47% of the remaining variation (total R²=63%). The factors identified as significant were: the percentage of total emergency admissions to hospital with a length of stay of exactly 1 day; the number of general practice nurses per 1 00 000 population; and, the percentage of general practitioners that had effective access to social workers.
Conclusion Having allowed for non-modifiable by service factors, almost half of the variation in emergency admissions for urgent conditions was explained by the availability of primary care and hospital resources. Therefore, increased access to, and use of, community-based primary care may reduce the number of inappropriate admissions.
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