Opportunities for primary care to reduce hospital admissions: a cross-sectional study of geographical variation

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Background: Reducing unplanned hospital admissions is a key priority within the UK. Substantial inter-practice variation in ambulatory care sensitive condition (ACSC) admission rates suggests that decreases might be possible.

Aim: To identify the clinical areas and patient subgroups where the greatest opportunities exist for general practitioners to improve ACSC care.

Design and Setting: Cross-sectional study using routine hospital data from patients registered at 8,123 English GP practices during 2011/12.

Method: We used random-effects Poisson models to estimate inter-practice variation after adjusting for several drivers of healthcare need and availability of local hospital services. We contrasted inter-practice variation across patient subgroups based on age.

Results: There were 1.8 million hospital admissions. Overall, high utilisation practices had ACSC admission rates 55% (95% CI: 53, 56) greater than low utilisation practices. Differences of 67% (95% CI: 65, 69) were found for chronic ACSCs which was much larger than the 51% (95% CI: 49, 52) difference exhibited by acute presentations. At least two-fold differences were found for 15 (54%) ACSCs although large inter-practice variations were not ubiquitous. Admission rates were consistently more variable among younger-than-average patients. The most variable conditions tended to disproportionately affect deprived patients.

Conclusions: Substantial inter-practice variation suggests that current efforts to standardise primary care have had a limited effect on unplanned hospital admissions. GPs and healthcare commissioners should ensure they are offering ‘best practice’ care for the most variable clinical areas and patient subgroups identified in our study, particularly in adults aged under 70 with chronic conditions.
Original languageEnglish
Pages (from-to)e20-e28
Number of pages9
JournalBritish Journal of General Practice
Issue number654
Early online date25 Oct 2016
Publication statusPublished - Jan 2017


  • Primary Health Care
  • General Practice
  • Geographical distribution
  • Ambulatory care
  • Patient Admission/sn


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