Evidence map›Paper›PMID 30795737›Full record

ArticleBMC family practice2019

The impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions (ACSCs) in Scotland: longitudinal analysis.

Marjon van der Pol, Damilola Olajide, Mark Dusheiko, Robert Elliott, Bruce Guthrie, Louisa Jorm, Alastair H Leyland

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In one paragraph

Article in BMC family practice, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Marjon van der PolHealth Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK. m.vanderpol@abdn.ac.uk.ORCID 0000-0003-0636-1184
Damilola OlajideHealth Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
Mark DusheikoUniversity of Lausanne, Lausanne, Switzerland.
Robert ElliottHealth Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
Bruce GuthrieUniversity of Dundee, Dundee, UK.
Louisa JormUNSW Australia, Sydney, Australia.
Alastair H LeylandUniversity of Glasgow, Glasgow, UK.

Funding

Chief Scientist Office CZH/4/916Chief Scientist Office HERU1Chief Scientist Office SPHSU13Medical Research Council MC_UU_12017/13
6 · The paper itself

Abstract

backgroundHospital admissions for Ambulatory Care Sensitive Conditions (ACSC) are those that could potentially be prevented by timely and effective disease management within primary care. ACSC admissions are increasingly used as performance indicators. However, key questions remain about the validity of these measures. The evidence to date has been inconclusive and limited to specific conditions. The aim of this study was to test the robustness of ACSC admissions as indicators of the quality of primary care. It is the first study to examine a wide range of ACSCs using longitudinal data which enables us to control for unmeasured characteristics which differ by practice but which are constant over time.

methodsUsing longitudinal data at the practice level, from 907 Scottish practices for the time period 1/4/2005 to 31/32012, we explored the relationships between the quality of primary care, and hospital admissions for multiple ACSCs controlling for a wide range of covariates including characteristics of GP practices, characteristics of the practice population, hospital effects and year effects. We examined the impact of two dimensions of quality of care: clinical quality of and access to daytime general practice. Generalised Estimating Equations taking the form of Negative Binomial regression models with the practice population included as the exposure term were estimated.

resultsWe found that higher achievement on some clinical quality measures of primary care was associated with reduced ACSC emergency admissions. We also show that access to primary care was associated with ACSC emergency admissions. However, the effects were small and inconsistent and ACSC emergency admissions were associated with several confounding factors such as deprivation, rurality and distance to the hospital.

conclusionsThe results suggest caution in the use of crude ACSC admission rates as a performance indicator of quality of primary care.

Indexed as

Health Services AccessibilityPrimary Health CareQuality of Health CareAmbulatory CareAngina PectorisAsthmaChronic DiseaseDiabetes MellitusEmergenciesEpilepsyHospitalizationHumansHypertensionLongitudinal StudiesPulmonary Disease, Chronic ObstructiveRetrospective StudiesAmbulatory care sensitive conditionsEmergency admissionsPrimary care

Identifiers

PMID30795737
PMCPMC6385424

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.