Top

Published in:

Open Access 01-12-2019 | Care | Research article

Patient consultation rate and clinical and NHS outcomes: a cross-sectional analysis of English primary care data from 2.7 million patients in 238 practices

Authors: Sarah Lay-Flurrie, Edouard Mathieu, Clare Bankhead, Brian D. Nicholson, Rafael Perera-Salazar, Tim Holt, F. D. Richard Hobbs, Chris Salisbury, on behalf of the NIHR School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford

Published in: BMC Health Services Research | Issue 1/2019

Abstract

Background

Primary care workload is high and increasing in the United Kingdom. We sought to examine the association between rates of primary care consultation and outcomes in England.

Methods

Cross sectional observational study of routine electronic health care records in 283 practices from the Clinical Practice Research Datalink from April 2013 to March 2014. Outcomes included mortality rate, hospital admission rate, Quality and Outcomes Framework (QOF) performance and patient satisfaction. Relationships between consultation rates (with a general practitioner (GP) or nurse) and outcomes were investigated using negative binomial and ordinal logistic regression models.

Results

Rates of GP and nurse consultation (per patient person-year) were not associated with mortality or hospital admission rates: mortality incidence rate ratio (IRR) per unit change in GP/ nurse consultation rate = 1.01, 95% CI [0.98 to 1.04]/ 0.97, 95% CI [0.93 to 1.02]; hospital admission IRR per unit change in GP/ nurse consultation rate = 1.02, 95% CI [0.99 to 1.04]/ 0.98, 95% CI [0.94 to 1.032]. Higher rates of nurse but not GP consultation were associated with higher QOF achievement: OR = 1.91, 95% CI [1.39 to 2.62] per unit change in nurse consultation rate vs. OR = 1.04, 95% CI [0.87 to 1.24] per unit change in GP consultation rate. The association between the rates of GP/ nurse consultations and patient satisfaction was mixed.

Conclusion

There are few associations between primary care consultation rates and outcomes. Previously identified demographic and staffing factors, rather than practice workload, appear to have the strongest relationships with mortality, admissions, performance and satisfaction. Studies with more detailed patient-level data would be required to explore these findings further.

Available only for authorised users

Hobbs FDR, Bankhead C, Mukhtar T, Stevens S, Perera-Salazar R, Holt T, et al. Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007–14. Lancet. 2016;387:2323–30.CrossRef

Wittenberg R, Sharpin L, McCormick B, Hurst J. The ageing society and emergency hospital admissions. Health Policy (New York) [Internet]. 2017;121(8):923–8. Available from: https://www.sciencedirect.com/science/article/pii/S0168851017301458?via%3Dihub. Accessed 6 July 2018.CrossRef

Huntley A, Lasserson D, Wye L, Morris R, Checkland K, England H, et al. Which features of primary care affect unscheduled secondary care use? A systematic review. BMJ Open [Internet]. 2014;4(5):e004746. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24860000. Accessed 6 July 2018.CrossRef

Gunther S, Taub N, Rogers S, Baker R. What aspects of primary care predict emergency admission rates? A cross sectional study. BMC Health Serv Res [Internet]. 2013;13(1):11. Available from: http://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-13-11. Accessed 17 July 2018.

Cowling TE, Cecil E V., Soljak MA, Lee JT, Millett C, Majeed A, et al. Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study. Spilsbury K, editor. PLoS One [Internet]. 2013;8(6):e66699. Available from: http://dx.plos.org/10.1371/journal.pone.0066699. Accessed 6 July 2018.

Barker I, Steventon A, Deeny SR. Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data. BMJ [Internet]. 2017;356:j84. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28148478. Accessed 6 July 2018.

Pereira Gray DJ, Sidaway-Lee K, White E, Thorne A, Evans PH. Continuity of care with doctors-a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open [Internet]. 2018;8(6):e021161. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29959146. Accessed 6 July 2018.CrossRef

Wolinsky FD, Bentler SE, Liu L, Geweke JF, Cook EA, Obrizan M, et al. Continuity of Care with a Primary Care Physician and Mortality in Older Adults. Journals Gerontol Ser A Biol Sci Med Sci [Internet]. 2010;65A(4):421–8. Available from: https://academic.oup.com/biomedgerontology/article-lookup/doi/10.1093/gerona/glp188. Accessed 6 July 2018.CrossRef

Prentice JC, Pizer SD. Delayed access to health care and mortality. Health Serv Res [Internet]. 2007;42(2):644–62. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17362211. Accessed 17 July 2018.CrossRef

10.

Jerant A, Fenton JJ, Franks P. Primary Care Attributes and Mortality: A National Person-Level Study. Ann Fam Med [Internet]. 2012;10(1):34–41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22230828. Accessed 17 July 2018.CrossRef

11.

Griffiths P, Murrells T, Maben J, Jones S, Ashworth M. Nurse staffing and quality of care in UK general practice: cross-sectional study using routinely collected data. Br J Gen Pract. 2010;60(570):34–9.CrossRef

12.

Kontopantelis E, Roland M, Reeves D. Patient experience of access to primary care: identification of predictors in a national patient survey. BMC Fam Pract [Internet]. 2010 Dec 28 [cited 2018 Jul 17];11(1):61. Available from: http://bmcfampract.biomedcentral.com/articles/10.1186/1471-2296-11-61

13.

Baker R, Streatfield J. What type of general practice do patients prefer? Exploration of practice characteristics influencing patient satisfaction. Br J Gen Pract [Internet]. 1995;45(401):654–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8745863. Accessed 6 July 2018.

14.

Herrett E, Gallagher AM, Bhaskaran K, Forbes H, Mathur R, van Staa T, et al. Data Resource Profile: Clinical Practice Research Datalink (CPRD). Int J Epidemiol [Internet]. 2015[;44(3):827–36. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4521131&tool=pmcentrez&rendertype=abstract. Accessed 7 June 2015.

15.

Health and Social Care Information Centre. General and personal medical services: England, 2004–2014, As at 30 September [Internet]. 2015. Available from: https://webarchive.nationalarchives.gov.uk/20180328135935/http://digital.nhs.uk/catalogue/PUB16934. Accessed 11 May 2015.

16.

NHS Digital. Dataset: Rural/Urban definition of GP practice: categorical, 2011 [Internet]. 2011. Available from: https://webarchive.nationalarchives.gov.uk/20140505141622/https://indicators.ic.nhs.uk/webview/index/en/MyServer/NHS-Information-Centre-indicators.c.MyServer/GP-Practice-data.d.48/Demography.d.77/GP-practice-location.d.201/Rural_Urban-definition-of-GP-practice-categorical-2011/fStudy/P01111. Accessed 11 May 2015.

17.

NHS England. GP patient survey practice report (July 2014 publication). 2014.

18.

Health and Social Care Information Centre. Quality and Outcomes Framework (QOF) - 2013-14 [Internet]. 2014. Available from: https://webarchive.nationalarchives.gov.uk/20180328134634/http://digital.nhs.uk/catalogue/PUB15751. Accessed 11 May 2015.

19.

Doran T, Fullwood C, Gravelle H, Reeves D, Kontopantelis E, Hiroeh U, et al. Pay-for-performance programs in family practices in the United Kingdom. N Engl J Med [Internet]. 2006;355(4):375–84. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16870916. Accessed 10 June 2015.CrossRef

20.

NHS England. Improving access to general practice [Internet]. 2018. Available from: https://www.england.nhs.uk/gp/gpfv/redesign/improving-access/. Accessed 11 Oct 2018.

21.

Newbould J, Abel G, Ball S, Corbett J, Elliott M, Exley J, et al. Evaluation of telephone first approach to demand management in English general practice: observational study. BMJ [Internet]. 2017;358:j4197. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28954741. Accessed 11 Oct 2018.

22.

NHS England. General practice – developing confidence, capability and capacity: A ten point action plan for general practice nursing [Internet]. 2017. Available from: https://www.england.nhs.uk/publication/general-practice-developing-confidence-capability-and-capacity/. Accessed 10 Dec 2018.

23.

Sansom A, Terry R, Fletcher E, Salisbury C, Long L, Richards SH, et al. Why do GPs leave direct patient care and what might help to retain them? A qualitative study of GPs in South West England. BMJ Open [Internet]. 2018 Jan 10 [cited 2018 Oct 12];8(1):e019849. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29326195.CrossRef

24.

Fletcher E, Abel GA, Anderson R, Richards SH, Salisbury C, Dean SG, et al. Quitting patient care and career break intentions among general practitioners in South West England: findings of a census survey of general practitioners. BMJ Open [Internet]. 2017 Apr 11 [cited 2018 Oct 12];7(4):e015853. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28446528.CrossRef

Title: Patient consultation rate and clinical and NHS outcomes: a cross-sectional analysis of English primary care data from 2.7 million patients in 238 practices
Authors: Sarah Lay-Flurrie
Edouard Mathieu
Clare Bankhead
Brian D. Nicholson
Rafael Perera-Salazar
Tim Holt
F. D. Richard Hobbs
Chris Salisbury
on behalf of the NIHR School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford
Publication date: 01-12-2019
Publisher: BioMed Central
Keyword: Care
Published in: BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-019-4036-y

At a glance: The STEP trials

Springer Medicine

Patient consultation rate and clinical and NHS outcomes: a cross-sectional analysis of English primary care data from 2.7 million patients in 238 practices

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2019

Development of the Patient’s Experience and Attitude Colposcopy Eindhoven Questionnaire (PEACE-q)

The salt between the beans: a qualitative study of the role of auxiliary midwives in a hard-to-reach area of Myanmar

Taking note: A qualitative study of implementing a scribing practice in team-based primary care clinics

The importance of herbal medicine use in the German health-care system: prevalence, usage pattern, and influencing factors

Challenges to the implementation of malaria policies in Malawi

Adaption and validation of Nijmegen continuity questionnaire to recognize the influencing factors of continuity of care for hypertensive patients in China