Do difficulties in accessing in-hours primary care predict higher use of out-of-hours GP services? Evidence from an English National Patient Survey.
BACKGROUND
It is believed that some patients are more likely to use out-of-hours primary care services because of difficulties in accessing in-hours care, but substantial evidence about any such association is missing.


METHODS
We analysed data from 567,049 respondents to the 2011/2012 English General Practice Patient Survey who reported at least one in-hours primary care consultation in the preceding 6 months. Of those respondents, 7% also reported using out-of-hours primary care. We used logistic regression to explore associations between use of out-of-hours primary care and five measures of in-hours access (ease of getting through on the telephone, ability to see a preferred general practitioner, ability to get an urgent or routine appointment and convenience of opening hours). We illustrated the potential for reduction in use of out-of-hours primary care in a model where access to in-hours care was made optimal.


RESULTS
Worse in-hours access was associated with greater use of out-of-hours primary care for each access factor. In multivariable analysis adjusting for access and patient characteristic variables, worse access was independently associated with increased out-of-hours use for all measures except ease of telephone access. Assuming these associations were causal, we estimated that an 11% relative reduction in use of out-of-hours primary care services in England could be achievable if access to in-hours care were optimal.


CONCLUSIONS
This secondary quantitative analysis provides evidence for an association between difficulty in accessing in-hours care and use of out-of-hours primary care services. The findings can motivate the development of interventions to improve in-hour access.
Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, Cambridgeshire, UK.
Yin
Y
Zhou
Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, Cambridgeshire, UK.
Gary
G
Abel
Primary Care Research Group, Peninsula Medical School, Plymouth, Exeter, UK.
Fiona
F
Warren
Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, Cambridgeshire, UK.
Martin
M
Roland
Primary Care Research Group, Peninsula Medical School, Plymouth, Exeter, UK.
John
J
Campbell
Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, Cambridgeshire, UK.
Georgios
G
Lyratzopoulos
D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D004739:England; D005260:Female; D058005:General Practitioners; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011320:Primary Health Care / Q000706:statistics & numerical data*; D013689:Telephone; D055815:Young Adult
Prehospital Care; Prehospital Care, Doctors in PHC; Primary Care