The association between emergency admissions for asthma and access to English primary care; national database cross sectional analysis

The problem

In the UK, there are over five million people with asthma. Poor control is known to be widespread despite effective treatments and guidelines. On average, 22 people die and 1400 are hospitalized every week costing the NHS over £1 billion. Access to primary care may be an important determining factor for the number of emergency admissions for asthma as early treatment of exacerbations has been shown to reduce unscheduled admissions and A&E attendances. We aimed to determine whether access to primary care is associated with emergency hospital admissions for asthma.

The approach

We constructed a retrospective cross sectional database of routine data at the practice level from the Health and Social Care Information Centre and the Eastern Region Public Health Observatory. This included data from English general practices in 2010/11 with 58,055 emergency admissions for asthma. Linear regression was used to explore associations. The outcome measure was the rate of emergency admissions in patients with asthma, and the main explanatory variable was patient reported access to general practice services from the GP patient survey. Other explanatory variables were practice size, deprivation, QOF performance in asthma indicators, ethnicity, and distance of the practice from the nearest hospital that takes asthma emergency admissions (calculated using the Geographical Information System (GIS) package ArcGIS v10.1).

Findings

7887 (96%) of English general practices had full sets of data for analysis. 2% of the practice population with asthma had an emergency admission for asthma, with a total of 58,055 emergency admissions. A very small number of practices (48, 0.58%) had high rates of emergency admissions for asthma over 10%. Admission rates for asthma were higher for those practices which had lower access scores, were closer to hospital, and had higher white and more deprived populations. There were no associations between admission rates and the quality of asthma care as measured by current QOF asthma indicators.

Consequences

General practices providing more timely access to primary care had fewer emergency admissions for asthma. Policy makers should consider interventions to improve access to primary care when developing strategies to reduce emergency asthma admissions. The lack of association between emergency asthma admissions and performance in QOF asthma indicators suggest that resources and incentives should be diverted towards strategies with evidence for improving outcomes. Examples are risk stratification and improved education of patients and clinicians, which have been recommended by the Royal College of Physicians' National Review of Asthma Deaths. Further, our model explained only 5.1% of the variation in emergency admission rates indicating that most of the variation between practices in emergency admissions for asthma is currently unexplained. More research is needed to identify what these factors might be.

Credits

• Robert Fleetcroft, Acle Medical Partnership, Norfolk, UK
• Aidan Martin, Acle Medical Partnership, Norfolk, UK
• Mike Noble
• Emma Coombes, Acle Medical Partnership, Norfolk, UK