title: Access to primary care and visits to emergency departments in England: a cross-sectional, population-based study.
abstract: BACKGROUND
  The number of visits to hospital emergency departments (EDs) in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS). Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England.
  
  
  METHODS
  A cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services. MAIN RESULT AND CONCLUSION: General practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001). Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, United Kingdom. t.cowling@imperial.ac.uk
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Cowling
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Cecil
authors.forename: Michael A
authors.initials: MA
authors.lastname: Soljak
authors.forename: John Tayu
authors.initials: JT
authors.lastname: Lee
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
authors.forename: Robert M
authors.initials: RM
authors.lastname: Wachter
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Harris
mesh_terms: D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D013997:Time Factors