title: Which features of primary care affect unscheduled secondary care use? A systematic review.
abstract: OBJECTIVE
  To conduct a systematic review to identify studies that describe factors and interventions at primary care practice level that impact on levels of utilisation of unscheduled secondary care.
  
  
  METHODS
  Observational studies at primary care practice level.
  
  
  METHODS
  Studies included people of any age of either sex living in Organisation for Economic Co-operation and Development (OECD) countries with any health condition.
  
  
  METHODS
  The primary outcome measure was unscheduled secondary care as measured by emergency department attendance and emergency hospital admissions.
  
  
  RESULTS
  48 papers were identified describing potential influencing features on emergency department visits (n=24 studies) and emergency admissions (n=22 studies). Patient factors associated with both outcomes were increased age, reduced socioeconomic status, lower educational attainment, chronic disease and multimorbidity. Features of primary care affecting unscheduled secondary care were more complex. Being able to see the same healthcare professional reduced unscheduled secondary care. Generally, better access was associated with reduced unscheduled care in the USA. Proximity to healthcare provision influenced patterns of use. Evidence relating to quality of care was limited and mixed.
  
  
  CONCLUSIONS
  The majority of research was from different healthcare systems and limited in the extent to which it can inform policy. However, there is evidence that continuity of care is associated with reduced emergency department attendance and emergency hospital admissions.
authors.affiliation: School of Community & Social Medicine, Centre of Academic Primary Care, University of Bristol, Bristol, UK.
authors.forename: Alyson
authors.initials: A
authors.lastname: Huntley
authors.affiliation: Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lasserson
authors.affiliation: School of Community & Social Medicine, Centre of Academic Primary Care, University of Bristol, Bristol, UK.
authors.forename: Lesley
authors.initials: L
authors.lastname: Wye
authors.affiliation: Primary Care & Population Health, Royal Free Campus, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Morris
authors.affiliation: Institute of Population Health, Centre for Primary Care, University of Manchester, Manchester, UK.
authors.forename: Kath
authors.initials: K
authors.lastname: Checkland
authors.affiliation: School of Community & Social Medicine, Centre of Academic Primary Care, University of Bristol, Bristol, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: England
authors.affiliation: School of Community & Social Medicine, Centre of Academic Primary Care, University of Bristol, Bristol, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Salisbury
authors.affiliation: School of Community & Social Medicine, Centre of Academic Primary Care, University of Bristol, Bristol, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Purdy
mesh_terms: D004632:Emergency Medical Services; D006760:Hospitalization; D006801:Humans; D011320:Primary Health Care; D063127:Secondary Health Care / Q000706:statistics & numerical data*
keywords: Accident & Emergency Medicine; Primary Care