The impact of a named GP scheme on continuity of care and emergency hospital admission: a cohort study among older patients in England, 2012–2016
Objective To investigate whether the introduction of a named general practitioner (GP, family physician) improved patients’ healthcare for patients aged 75 and over in England.Setting Random sample of 27 500 patients aged 65 to 84 in 2012 within 139 English practices from the Clinical Practice Resea...
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BMJ Publishing Group
2019-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/9/e029103.full |
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| author | Rupert A Payne Chris Salisbury Richard W Morris Melanie Chalder Peter Tammes |
| author_facet | Rupert A Payne Chris Salisbury Richard W Morris Melanie Chalder Peter Tammes |
| author_sort | Rupert A Payne |
| collection | DOAJ |
| description | Objective To investigate whether the introduction of a named general practitioner (GP, family physician) improved patients’ healthcare for patients aged 75 and over in England.Setting Random sample of 27 500 patients aged 65 to 84 in 2012 within 139 English practices from the Clinical Practice Research Datalink linked with Hospital Episode Statistics.Design Prospective cohort approach, measuring patients’ GP consultations and emergency hospital admissions 2 years before/after the intervention. Patients were grouped in (i) aged over 74 and (ii) younger than 75 in both periods in order to compare who were or were not subject to the intervention. Adjusted associations between the named GP scheme, continuity of care and emergency hospital admission were examined using multilevel modelling.Intervention National Health Service policy to introduce a named accountable GP for patients aged over 74 in April 2014.Main outcome measures (A) Continuity of care index-score, (B) risk of emergency hospital admissions, (C) number of emergency hospital admissions.Results The intervention was associated with a decrease in continuity index-scores of −0.024 (95% CI −0.030 to −0.018, p<0.001); there were no differences in the decrease between the two age groups (−0.005, 95% CI −0.014 to 0.005). In the pre-intervention and post-intervention periods, respectively, 15.4% and 19.4% patients had an emergency admission. The probability of an emergency hospital admission increased after the intervention (OR 1.156, 95% CI 1.064 to 1.257, p=0.001); this increase was bigger for patients over 74 (relative OR 1.191, 95% CI 1.066 to 1.330, p=0.002). The average number of emergency hospital admissions increased after the intervention (rate ratio (RR) 1.178, 95% CI 1.103 to 1.259, p<0.001); this increase was greater for patients over 74 (relative RR 1.143, 95% CI 1.052 to 1.242, p=0.001).Conclusion The introduction of the named GP scheme was not associated with improvements in either continuity of care or rates of unplanned hospitalisation. |
| format | Article |
| id | doaj-art-65611fd8f2be4ef6a1b726b9d4d1b79b |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-65611fd8f2be4ef6a1b726b9d4d1b79b2025-08-20T02:07:12ZengBMJ Publishing GroupBMJ Open2044-60552019-09-019910.1136/bmjopen-2019-029103The impact of a named GP scheme on continuity of care and emergency hospital admission: a cohort study among older patients in England, 2012–2016Rupert A Payne0Chris Salisbury1Richard W Morris2Melanie Chalder3Peter Tammes44 University of Bristol Centre for Academic Primary Care, Bristol, Bristol, UKCentre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK4 Central Clinical School, University of Sydney, Sydney, New South Wales, Australiaresearch fellowBristol Medical School: Population Health Sciences, Centre for Academic Primary Care, University of Bristol, Bristol, UKObjective To investigate whether the introduction of a named general practitioner (GP, family physician) improved patients’ healthcare for patients aged 75 and over in England.Setting Random sample of 27 500 patients aged 65 to 84 in 2012 within 139 English practices from the Clinical Practice Research Datalink linked with Hospital Episode Statistics.Design Prospective cohort approach, measuring patients’ GP consultations and emergency hospital admissions 2 years before/after the intervention. Patients were grouped in (i) aged over 74 and (ii) younger than 75 in both periods in order to compare who were or were not subject to the intervention. Adjusted associations between the named GP scheme, continuity of care and emergency hospital admission were examined using multilevel modelling.Intervention National Health Service policy to introduce a named accountable GP for patients aged over 74 in April 2014.Main outcome measures (A) Continuity of care index-score, (B) risk of emergency hospital admissions, (C) number of emergency hospital admissions.Results The intervention was associated with a decrease in continuity index-scores of −0.024 (95% CI −0.030 to −0.018, p<0.001); there were no differences in the decrease between the two age groups (−0.005, 95% CI −0.014 to 0.005). In the pre-intervention and post-intervention periods, respectively, 15.4% and 19.4% patients had an emergency admission. The probability of an emergency hospital admission increased after the intervention (OR 1.156, 95% CI 1.064 to 1.257, p=0.001); this increase was bigger for patients over 74 (relative OR 1.191, 95% CI 1.066 to 1.330, p=0.002). The average number of emergency hospital admissions increased after the intervention (rate ratio (RR) 1.178, 95% CI 1.103 to 1.259, p<0.001); this increase was greater for patients over 74 (relative RR 1.143, 95% CI 1.052 to 1.242, p=0.001).Conclusion The introduction of the named GP scheme was not associated with improvements in either continuity of care or rates of unplanned hospitalisation.https://bmjopen.bmj.com/content/9/9/e029103.full |
| spellingShingle | Rupert A Payne Chris Salisbury Richard W Morris Melanie Chalder Peter Tammes The impact of a named GP scheme on continuity of care and emergency hospital admission: a cohort study among older patients in England, 2012–2016 BMJ Open |
| title | The impact of a named GP scheme on continuity of care and emergency hospital admission: a cohort study among older patients in England, 2012–2016 |
| title_full | The impact of a named GP scheme on continuity of care and emergency hospital admission: a cohort study among older patients in England, 2012–2016 |
| title_fullStr | The impact of a named GP scheme on continuity of care and emergency hospital admission: a cohort study among older patients in England, 2012–2016 |
| title_full_unstemmed | The impact of a named GP scheme on continuity of care and emergency hospital admission: a cohort study among older patients in England, 2012–2016 |
| title_short | The impact of a named GP scheme on continuity of care and emergency hospital admission: a cohort study among older patients in England, 2012–2016 |
| title_sort | impact of a named gp scheme on continuity of care and emergency hospital admission a cohort study among older patients in england 2012 2016 |
| url | https://bmjopen.bmj.com/content/9/9/e029103.full |
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