title: Socioeconomic deprivation and accident and emergency attendances: cross-sectional analysis of general practices in England.
abstract: BACKGROUND
  Demand for England's accident and emergency (A&E) services is increasing and is particularly concentrated in areas of high deprivation. The extent to which primary care services, relative to population characteristics, can impact on A&E is not fully understood.
  
  
  OBJECTIVE
  To conduct a detailed analysis to identify population and primary care characteristics associated with A&E attendance rates, particularly those that may be amenable to change by primary care services.
  
  
  METHODS
  This study used a cross-sectional population-based design. The setting was general practices in England, in the year 2011-2012.
  
  
  METHODS
  Multivariate linear regression analysis was used to create a model to explain the variability in practice A&E attendance rates. Predictor variables included population demographics, practice characteristics, and measures of patient experiences of primary care.
  
  
  RESULTS
  The strongest predictor of general practice A&E attendance rates was social deprivation: the Index of Multiple Deprivation (IMD-2010) (β = 0.3. B = 1.4 [95% CI =1.3 to 1.6]), followed by population morbidity (GPPS responders reporting a long-standing health condition) (β = 0.2, B = 231.5 [95% CI = 202.1 to 260.8]), and knowledge of how to contact an out-of-hours GP (GPPS question 36) (β = -0.2, B = -128.7 [95% CI =149.3 to -108.2]). Other significant predictors included the practice list size (β = -0.1, B = -0.002 [95% CI = -0.003 to -0.002]) and the proportion of patients aged 0-4 years (β = 0.1, B = 547.3 [95% CI = 418.6 to 676.0]). The final model explained 34.4% of the variation in A&E attendance rates, mostly due to factors that could not be modified by primary care services.
  
  
  CONCLUSIONS
  Demographic characteristics were the strongest predictors of A&E attendance rates. Primary care variables that may be amenable to change only made a small contribution to higher A&E attendance rates.
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London.
authors.forename: Rachel
authors.initials: R
authors.lastname: Scantlebury
authors.affiliation: Institute of Public Health, Aarhus University, Aarhus, Denmark, and Institute for Health and Society, Newcastle University, Newcastle, UK.
authors.forename: Gillian
authors.initials: G
authors.lastname: Rowlands
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London.
authors.forename: Stevo
authors.initials: S
authors.lastname: Durbaba
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London.
authors.forename: Peter
authors.initials: P
authors.lastname: Schofield
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London.
authors.forename: Kalwant
authors.initials: K
authors.lastname: Sidhu
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London.
authors.forename: Mark
authors.initials: M
authors.lastname: Ashworth
mesh_terms: D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D058006:General Practice / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011204:Poverty Areas; D013222:State Medicine / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology
keywords: accident and emergency department; general practice; primary health care; socioeconomic factors