Older patients and those with long term conditions are less likely to be high users of walk-in appointments in general practice: a cross sectional study of electronic health records

Problem

As timely access is seen as a key aspect of quality primary care, general practices may offer same-day appointments to patients by setting aside consultation time that can be accessed on a ‘walk-in’ basis, rather than appointments arranged through the practice receptionist. This form of access may not serve the needs of all patients - we analyse which patients are most likely to utilise different appointment types, and the impact of walk-in appointments on utilisation.

Approach

We analysed electronic health records (22nd September 2015 - 21st September 2016) for all 25,252 patients registered at a large general practice in South East London, where walk-in appointments were introduced in January 2016. These contained each patient’s age, sex, deprivation at area of residence, number of long-term conditions, prescriptions, emergency department attendances, inpatient admissions and household size.We classed appointments into pre-booked (either telephone or in-person appointments arranged through the practice receptionist) or walk-in. ‘High users’ were defined relative to overall utilisation, >12 for pre-booked appointments and >5 for walk-in appointments.We employed multivariable logistic regression models to establish the association between patient and household characteristics, and high use of each appointment type.We used a simple time series trend analysis to examine whether older patients (65+) and those with long term conditions changed their overall utilisation following the introduction of walk-in appointments.

Findings

Our cohort was 51% female, on average 31 (SD 19.88) years of age, with 0.49 (SD 1.01) long-term conditions. The average patient had 0.20 (SD 0.31) pre-booked appointments and 0.10 (SD 0.10) walk-in appointments per month. There were 502 high users of pre-booked appointments and 554 high users of walk-in appointments.Controlling for other factors, patients with one additional long-term condition from the mean were more likely to be a high user of pre-booked appointments (OR 1.61, 95% CI 1.50 - 1.74) and, with a smaller magnitude, of walk-in appointments (OR 1.21, 95% CI 1.11 - 1.31). Patients aged 80+ were less likely (OR 0.52 95% CI 0.27 - 1.00) to be a high user of walk-in appointments when compared to the reference age group (ages 40 – 60). Our time series analysis found that the introduction of walk-in appointments had no effect on overall utilisation for older patients and those with long-term conditions.

Consequences

We have shown that older patients were less likely to use walk-in appointments, and those with long-term condition were more likely to use pre-booked appointments. Future work could identify impact on patient outcomes and service usage in the whole health economy.