Relation of out of hours activity by general practice and accident and emergency services with deprivation in Nottingham: longitudinal survey.
OBJECTIVE
To investigate the relation between out of hours activity of general practice and accident and emergency services with deprivation and distance from accident and emergency department.


METHODS
Six month longitudinal study.


METHODS
Six general practices and the sole accident and emergency department in Nottingham.


METHODS
4745 out of hours contacts generated by 45,182 patients from 23 electoral wards registered with six practices.


METHODS
Rates of out of hours contacts for general practice and accident and emergency services calculated by electoral ward; Jarman and Townsend deprivation scores and distance from accident and emergency department of electoral wards.


RESULTS
Distances of wards from accident and emergency department ranged from 0.8 to 9 km, and Jarman deprivation scores ranged from -23.4 to 51.8. Out of hours contacts varied by ward from 110 to 350 events/1000 patients/year, and 58% of this variation was explained by the Jarman score. General practice and accident and emergency rates were positively correlated (Pearson coefficient 0.50, P = 0.015). Proximity to accident and emergency department was not significantly associated with increased activity when deprivation was included in regression analysis. One practice had substantially higher out of hours activity (B coefficient 124 (95% confidence interval 67 to 181)) even when deprivation was included in regression analysis.


CONCLUSIONS
A disproportionate amount of out of hours workload fell on deprived inner city practices. High general practice and high accident and emergency activity occurred in the same areas rather than one service substituting for the other.
Carlisle
R
R
Division of General Practice, University of Nottingham, University Hospital.
Groom
L M
LM
Avery
A J
AJ
Boot
D
D
Earwicker
S
S
D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005194:Family Practice / Q000706:statistics & numerical data*; D006693:Holidays; D006801:Humans; D008137:Longitudinal Studies; D009551:Night Care; D011204:Poverty Areas; D017062:Small-Area Analysis; D013997:Time Factors; D019037:Urban Health Services / Q000706:statistics & numerical data; D014600:Utilization Review; D016526:Workload / Q000706:statistics & numerical data