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 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...
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| Format: | Article |
| Language: | English |
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BMC
2019-04-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-019-4036-y |
| _version_ | 1818153629869146112 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Sarah Lay-Flurrie |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T14:13:40Z |
| format | Article |
| id | doaj.art-39836ad8cc3a43ae8bd65ba528a50fd4 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-11T14:13:40Z |
| publishDate | 2019-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-39836ad8cc3a43ae8bd65ba528a50fd42022-12-22T01:03:16ZengBMCBMC Health Services Research1472-69632019-04-011911710.1186/s12913-019-4036-yPatient consultation rate and clinical and NHS outcomes: a cross-sectional analysis of English primary care data from 2.7 million patients in 238 practicesSarah Lay-Flurrie0Edouard Mathieu1Clare Bankhead2Brian D. Nicholson3Rafael Perera-Salazar4Tim Holt5F. D. Richard Hobbs6Chris Salisbury7on behalf of the NIHR School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of OxfordNuffield Department of Primary Care Health Sciences, University of OxfordNuffield Department of Primary Care Health Sciences, University of OxfordNuffield Department of Primary Care Health Sciences, University of OxfordNuffield Department of Primary Care Health Sciences, University of OxfordNuffield Department of Primary Care Health Sciences, University of OxfordNuffield Department of Primary Care Health Sciences, University of OxfordNuffield Department of Primary Care Health Sciences, University of OxfordCentre for Academic Primary Care, Bristol Medical School, University of BristolAbstract 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.http://link.springer.com/article/10.1186/s12913-019-4036-yGeneral practiceWorkloadMortalityQuality of careHospitalization |
| spellingShingle | 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 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 BMC Health Services Research General practice Workload Mortality Quality of care Hospitalization |
| 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | General practice Workload Mortality Quality of care Hospitalization |
| url | http://link.springer.com/article/10.1186/s12913-019-4036-y |
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