‘Patient journeys into hospital’. An in-depth exploration of primary care’s role in the emergency admission of older people with multimorbidity.

IntroductionLevels of emergency hospital admissions in multimorbidity are high. Many of these admissions could be avoided.AimTo understand the primary care factors and decision making associated with emergency GP hospital admissions for patients with multimorbidity.MethodSeven case studies consisted of interviews with a patient or carer, GP and medical record reviews. Patients had more than one chronic disease and a recent emergency admission by their GP. Medical records were reviewed for twelve months prior to and including the admission. Maps of the patient journeys detailed key interactions. Two focus groups of GPs, six further patient/ carer interviews and seven practice manager interviews were completed. Framework analysis helped generate themes associated with the primary care factors leading up to and involved in the decision-making processes in context of an admission.ResultsPoor coordination of care within and between primary, community and secondary care was challenging for patients and GPs alike. Responsiveness of practices could have been timelier and collaborated better. Patients reported high trust in their GPs which increased agreement with management plans or admission. GPs and patients followed a structured admission decision pathway. Time pressures and worry re negative outcomes impacted on GP’s admission decisions. Prior knowledge of the patient, higher confidence levels in their condition and better access to support from secondary care colleagues assisted their decision. Level of trust in the GP and the language and context of their explanation influenced patient’s agreement to admission.ConclusionAs far as we are aware this is the first study in this area of its design. Improved collaboration and coordination within primary care teams and between primary and secondary care should the focus for improvement.</p

Rationalising Data Use for General Practice: A Missed Opportunity?

Rationalising Data Use for General Practice: A Missed Opportunity

Do practice deprivation scores predict declines in perceived relationship continuity? A longitudinal study.

Background Increased relationship continuity in primary care is associated with better health outcomes, greater patient satisfaction and fewer hospital admissions. Greater socio-economic deprivation is associated with lower levels of continuity, as well as poorer health outcomes. Aim To investigate whether deprivation scores predicted variations in the decline over time of patient-perceived relationship continuity of care, after adjustment for practice organisational and population factors. Design and Setting Observational study. Longitudinal multilevel linear model for 2012-2017 inclusive; 6,243 practices in England with more than one GP. Methods Relationship continuity was calculated using two questions from the General Practice Patient Survey. The effect of deprivation on the linear slope of continuity over time was modelled, adjusting for nine confounding variables (practice population and organisational factors). Clustering of measurements within general practices was adjusted for by modelling general practice as a random effect, using a random intercepts and random slopes model. Descriptive statistics and univariable analyses were also undertaken. Results Continuity declined by 27.5% between 2012 and 2017 and at all deprivation levels. Deprivation scores from 2012 did not predict variations in the decline of relationship continuity at practice level, after accounting for the effects of organisational and population confounding variables, which themselves did not predict (smokers, permanent disability and geographical location), or weakly predicted (Black or South Asian ethnicity, list size, over 75s, long-term conditions) with very small effect sizes, the decline of continuity. Crosssectionally, continuity and deprivation were negatively correlated within each year. Conclusion Deprivation scores did not predict decline in relationship continuity over time, which is persistent and widespread in English primary care

Population health needs as predictors of variations in NHS practice payments: a cross-sectional study of English general practices in 2013-2014 and 2014-2015.

BACKGROUND: NHS general practice payments in England include pay for performance elements and a weighted component designed to compensate for workload, but without measures of specific deprivation or ethnic groups. AIM: To determine whether population factors related to health needs predicted variations in NHS payments to individual general practices in England. DESIGN AND SETTING: Cross-sectional study of all practices in England, in financial years 2013-2014 and 2014-2015. METHOD: Descriptive statistics, univariable analyses (examining correlations between payment and predictors), and multivariable analyses (undertaking multivariable linear regressions for each year, with logarithms of payments as the dependent variables, and with population, practice, and performance factors as independent variables) were undertaken. RESULTS: Several population variables predicted variations in adjusted total payments, but inconsistently. Higher payments were associated with increases in deprivation, patients of older age, African Caribbean ethnic group, and asthma prevalence. Lower payments were associated with an increase in smoking prevalence. Long-term health conditions, South Asian ethnic group, and diabetes prevalence were not predictive. The adjusted R(2) values were 0.359 (2013-2014) and 0.374 (2014-2015). A slightly different set of variables predicted variations in the payment component designed to compensate for workload. Lower payments were associated with increases in deprivation, patients of older age, and diabetes prevalence. Smoking prevalence was not predictive. There was a geographical differential. CONCLUSION: Population factors related to health needs were, overall, poor predictors of variations in adjusted total practice payments and in the payment component designed to compensate for workload. Revising the weighting formula and extending weighting to other payment components might better support practices to address these needs

Predicting declines in perceived relationship continuity using practice deprivation scores: a longitudinal study in primary care.

BACKGROUND: Increased relationship continuity in primary care is associated with better health outcomes, greater patient satisfaction, and fewer hospital admissions. Greater socioeconomic deprivation is associated with lower levels of continuity, as well as poorer health outcomes. AIM: To investigate whether deprivation scores predicted variations in the decline over time of patient-perceived relationship continuity of care, after adjustment for practice organisational and population factors. DESIGN AND SETTING: An observational study in 6243 primary care practices with more than one GP, in England, using a longitudinal multilevel linear model, 2012-2017 inclusive. METHOD: Patient-perceived relationship continuity was calculated using two questions from the GP Patient Survey. The effect of deprivation on the linear slope of continuity over time was modelled, adjusting for nine confounding variables (practice population and organisational factors). Clustering of measurements within general practices was adjusted for by using a random intercepts and random slopes model. Descriptive statistics and univariable analyses were also undertaken. RESULTS: Relationship continuity declined by 27.5% between 2012 and 2017, and at all deprivation levels. Deprivation scores from 2012 did not predict variations in the decline of relationship continuity at practice level, after accounting for the effects of organisational and population confounding variables, which themselves did not predict, or weakly predicted with very small effect sizes, the decline of continuity. Cross-sectionally, continuity and deprivation were negatively correlated within each year. CONCLUSION: The decline in relationship continuity of care has been marked and widespread. Measures to maximise continuity will need to be feasible for individual practices with diverse population and organisational characteristics

Additional file 2: of Cluster randomised trial of a tailored intervention to improve the management of overweight and obesity in primary care in England

The NICE guideline recommendations for adults for primary care teams. (DOC 23 kb

Additional file 1: of Cluster randomised trial of a tailored intervention to improve the management of overweight and obesity in primary care in England

CONSORT checklist. (DOCX 24 kb