Ability to see preferred family doctor cuts hospital admissions
MedWire News: Giving patients the choice to consult a particular family doctor is linked to reduced elective admissions to hospital, a UK study has shown.
The authors say this finding could lead to significant cost savings to the healthcare system, and adds further weight to the importance of continuity of care.
Researchers from the University of Leicester sought to identify patient and general (family) practice predictors of elective admissions to hospitals in Leicestershire and Rutland, which has 145 practices serving around 940,000 people, over 2 consecutive years.
As reported in the Journal of Public Health, planned admissions increased between the 2 years, from a median of 582 in 2006-2007 to 633 in 2007-2008. Most of the practices scored highly on the Quality and Outcomes Framework - a pay-for-performance scheme - and patients' satisfaction with access was relatively high, although the authors note that at some practices only just over half reported being able to get an appointment with a particular general practitioner.
Using a negative binomial regression model to analyze the results, the researchers found that practices in which more patients were able to see a specific general practitioner were associated with lower numbers of elective admissions in both years.
For an average-sized general practice, each 1% increase in the proportion of patients able to see a particular doctor was associated with 7.6 fewer elective admissions per year in 2006-2007, and 3.1 fewer in 2007-2008. This was associated with an estimated £20,073 (US$ 32,356; € 24,544) reduction in costs to the National Health Service (NHS) in 2006-2007, and £8,965 (US$ 14,460; € 10,961) in 2007-2008.
Having more male patients at a practice was also associated with fewer admissions, while practices with more elderly patients, those with more White patients than patients of other ethnicities, and those with larger numbers of registered patients (in 2007-2008) had higher rates of admissions.
No associations were seen for pay-for-performance scores, deprivation, distance the patient lived from hospital, or other aspects of patient access analyzed.
ead researcher Richard Baker said: "The NHS needs to save money, and reducing hospitals is key to this. There is now a good deal of evidence that continuity in general practice - that is, patients are able to book appointments with a doctor they have come to know and trust - is associated with reduced hospital admissions.
"Unfortunately, however, various changes in the health system in recent years have tended to reduce continuity."
By Caroline Price