Exploring the relationship between general practice characteristics, and attendance at walk-in centres, minor injury units and emergency departments in England 2012/2013:A cross-sectional study

摘要

Background For several years, emergency departments (ED) in the UK National Health Service have faced considerable increases in attendance rates. Walk-in Centres (WiC), Minor Injuries Units (MIU) have been suggested as solutions. We aimed to investigate associations between practice and practice population characteristics with ED attendance rates or combined ED/WiC/MIU attendance, and associations between WiC/MIU, and ED attendance.Methods We used general practice-level data including 7,462 English practices in 2012/13, and present adjusted regression coefficients from linear multivariable analysis for relationships between patients’ emergency attendance rates and practice characteristics.Results Every percentage-point increase in patients reporting inability to make an appointment was associated with an increase in emergency attendance by 0.36 (95%CI 0.06, 0.66) per 1,000 population. Percentage-point increases in patients unable to speak to a GP/nurse within 2 workdays and patients able to speak often to their preferred GP were associated with increased emergency attendance/1,000 population by 0.23 (95%CI 0.05, 0.42) and 0.10 (95%CI 0.00, 0.19) respectively. Practices in areas encompassing several towns (conurbations) had higher attendance than rural practices, as did practices with more non-UK-qualified GPs. Practice population characteristics associated with increased emergency attendance included higher unemployment rates, higher percentage of UK-whites, and lower male life-expectancy, which showed stronger associations than practice characteristics. Furthermore, higher MIU or WiC attendance rates were associated with lower ED attendance rates. Conclusions Improving availability of appointments and opportunities to speak a GP/nurse at short notice might reduce ED attendance. Establishing MIUs and WiCs might also reduce ED attendance.