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

Peter Tammes; Rupert A. Payne; Chris Salisbury; Melanie Chalder; Sarah Purdy; Richard W. Morris

doi:10.1136/ bmjopen-2019-029103

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

Peter Tammes^*
, Rupert A. Payne
, Chris Salisbury
, Melanie Chalder
, Sarah Purdy
, Richard W. Morris

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

25 Citations (Scopus)

470 Downloads (Pure)

Abstract

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.

Original language	English
Article number	e029103
Number of pages	9
Journal	BMJ Open
Volume	9
Issue number	9
Early online date	23 Sept 2019
DOIs	https://doi.org/10.1136/ bmjopen-2019-029103 https://doi.org/10.1136/bmjopen-2019-029103
Publication status	Published - 23 Sept 2019

Bibliographical note

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

health policy
organisation of health services
primary care
public health
research methods
statistics &amp

Access to Document

Full-text PDF (final published version)
This is the final published version of the article (version of record). It first appeared online via BMJ Publishing Group at https://bmjopen.bmj.com/content/9/9/e029103 . Please refer to any applicable terms of use of the publisher.
Final published version, 401 KBLicence: CC BY
Full-text PDF (final published version)
This is the final published version of the article (version of record). It first appeared online via BMJ Publishing Group at https://bmjopen.bmj.com/content/9/9/e029103 . Please refer to any applicable terms of use of the publisher.
Final published version, 435 KBLicence: CC BY
Full-text PDF (final published version)
This is the final published version of the article (version of record). It first appeared online via BMJ at https://bmjopen.bmj.com/content/9/9/e029103. Please refer to any applicable terms of use of the publisher.
Final published version, 401 KBLicence: CC BY

Handle.net

Persistent link

Cite this

@article{5c4a4434d2ec4d16ae79403cb724c6eb,

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",

abstract = "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.",

keywords = "health policy, organisation of health services, primary care, public health, research methods, statistics \&amp",

author = "Peter Tammes and Payne, \{Rupert A.\} and Chris Salisbury and Melanie Chalder and Sarah Purdy and Morris, \{Richard W.\}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.",

year = "2019",

month = sep,

day = "23",

doi = "10.1136/ bmjopen-2019-029103",

language = "English",

volume = "9",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "9",

}

TY - JOUR

T1 - The impact of a named GP scheme on continuity of care and emergency hospital admission

T2 - A cohort study among older patients in England, 2012-2016

AU - Tammes, Peter

AU - Payne, Rupert A.

AU - Salisbury, Chris

AU - Chalder, Melanie

AU - Purdy, Sarah

AU - Morris, Richard W.

PY - 2019/9/23

Y1 - 2019/9/23

N2 - 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.

AB - 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.

KW - health policy

KW - organisation of health services

KW - primary care

KW - public health

KW - research methods

KW - statistics &amp

UR - https://www.scopus.com/pages/publications/85072552025

U2 - 10.1136/ bmjopen-2019-029103

DO - 10.1136/ bmjopen-2019-029103

M3 - Article (Academic Journal)

C2 - 31258918

SN - 2044-6055

VL - 9

JO - BMJ Open

JF - BMJ Open

IS - 9

M1 - e029103

ER -

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

Abstract

Bibliographical note

UN SDGs

Keywords

Access to Document

Handle.net

Other files and links

Embargoed Document

Embargoed Document

Fingerprint

Investigating the impact of the introduction of a named GP assigned to patients 75 and over on their continuity of care and utilisation of primary and secondary health care services.

Cite this

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

Abstract

Bibliographical note

UN SDGs

Keywords

Access to Document

Handle.net

Other files and links

Embargoed Document

Embargoed Document

Fingerprint

Projects

Investigating the impact of the introduction of a named GP assigned to patients 75 and over on their continuity of care and utilisation of primary and secondary health care services.

Cite this