title: Association of primary care factors with hospital admissions for epilepsy in England, 2004-2010: National observational study.
abstract: OBJECTIVE
  There has been little research on the accessibility and quality of primary care services for epilepsy and emergency hospital admissions for epilepsy.
  
  
  METHODS
  We examined time trends in admissions for epilepsy in England between 2004-2005 and 2010, and the association of admission rates with population and primary care factors. The units of analysis were the registered populations of 8622 general practices. We used negative binomial regression to model indicators from the Quality and Outcomes Framework, the UK's primary care pay for performance scheme, to measure the accessibility and quality of care for epilepsy, and supply of general practitioners, after adjustment for population factors.
  
  
  RESULTS
  The mean indirectly standardised admission rate decreased from 122.9 to 102.6 (-16.5%; P<0.001) over the study period, while the mean percentage of patients seizure free increased from 65.3% to 74.9% (P<0.001). In the multivariable analysis, a one unit increase in the percentage of seizure free adult patients on epilepsy drugs predicted a 0.20% decrease (IRR=0.9980; 95% CI: 0.9974-0.9986) in admission rate. The percentage of patients who were able to book a GP appointment over two days ahead predicted a 0.12% decrease (IRR=0.9988; 95% CI: 0.9982-0.9994). The deprivation score of practice populations (IRR=1.0179; P<0.001) and general practitioner supply (IRR=1.0022; P<0.001) were both positively associated with admission rates.
  
  
  CONCLUSIONS
  Patient access to primary care appointments and percentage of patients who have been recorded as seizure free for 12 months were associated with lower admission rates. However the effect sizes are small relative to that of population deprivation.
authors.affiliation: Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.
authors.forename: Amaia
authors.initials: A
authors.lastname: Calderón-Larrañaga
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK. Electronic address: m.soljak@imperial.ac.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: Soljak
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Cowling
authors.affiliation: Department, Shrewsbury and Telford Hospital NHS Trust, Princess Royal Hospital, Apley Castle, Telford TF1 6TF, UK.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Gaitatzis
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
mesh_terms: D004739:England; D004827:Epilepsy / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D058006:General Practice / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015233:Models, Statistical; D015999:Multivariate Analysis; D010343:Patient Admission / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012052:Reimbursement, Incentive; D012640:Seizures / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome
keywords: Access to health care; Epilepsy; Health services; Primary healthcare